Drastic increase in operations

Number of operations increased significantly - Economic reasons are crucial?

08/23/2013

The number of operations in German clinics increased by about 25 percent between 2005 and 2011. This is the answer of the Federal Government to a request of the parliamentary group „The left“ out. From around 12.1 million in 2005 to 15.3 million in 2011, the number of operations performed increased accordingly. In the opinion of the Left, disincentives in the system mean that surgeries are increasingly performed not on the basis of medical necessity, but on the basis of compensation.

Since 2005, the introduction of hospitals' diagnosis-related groups (DRGs) has led to the „Hospital services are no longer remunerated according to length of stay, but on a flat-rate basis according to diagnosis“, explained „The left“ in a preliminary remark to the answer of the Federal Government. The DRG in Germany would be used in contrast to all other countries as a pure price system. „As the fees for services rendered have increased more slowly than the costs in recent years, a vicious circle has been set in motion. Hospitals can only survive if they increase the number of cases“, so the left on. This means that either more patients need to be treated or the invasiveness of the treatment needs to be expanded - for example through more surgery or other procedures. A thesis that is quite supported by the numbers in the response of the federal government. The increase in operations by around 25 percent can not be explained by demographic change alone.

Disincentives in the health system
The Federal Government also indirectly acknowledges in its preliminary remarks that maladministration in the health system exists or has existed by stating that „initial measures to reduce incentives for non-medically indicated service provision have already been initiated“ were. In fact, the drastic increase in operations since the introduction of lump-sum payments seems to make the governing parties think too. Hardly surprising, since the number of procedures has more than doubled in some areas, such as in spinal surgery - from about 327,000 operations in 2005 to about 735,000 operations in 2011. In addition, the international comparison in the answer of the Federal Government that in Germany significantly more hip surgery, knee surgery but also caesarean sections are performed, as in other European countries. Overall, the willingness to undergo surgery in this country seems to be significantly increased.

Operations for economic reasons?
Whether the increased readiness to operate in German clinics due to disincentives or the case lump sums, can not be clearly determined on the basis of the response of the Federal Government, the suspicion is close. In the view of the left, the focus is no longer on the well-being of patients, but economic criteria are becoming increasingly important. „Time-consuming nursing or medical treatments or donations increase costs and are reduced for economic - not medical - reasons. This affects the quality of care“, so the conclusion of the left.

The health spokesman for the CDU parliamentary group, Jens Spahn, told the news agency „dpa“, There is no doubt that more is being operated in Germany than in other European countries. However, Spahn did not provide a possible justification, but referred to a study that should clarify this issue by the end of the year. Every patient must be able to rely on the fact that only medically necessary operations take place and are not operated in order to increase the turnover, so Spahn on. A statement that politicians of all parties can sign. The question, however, is how this approach will be taken into account in policy making. When health economics becomes the maxim of action, the problem is inevitable. Clinicians and physicians will always have the cost-benefit factor in mind when treating, which, if in doubt, can lead to discomfort for patients. (Fp)

Picture credits: Thommy Weiss