Die Kosten im Gesundheitswesen der Schweiz im Vergleich zu den OECD Daten. Eine erhellende Zusammenstellung von Gerhard Kocher in der Schweizerischen Aerztezeitung vom November 2009
"Es ist ausserordentlich bedauerlich, dass Schweizer Entscheidungsträger bisher mehrheitlich der gründlich deutschen DRG- und Marktgläubigkeit folgen und entgegen wissenschaftlicher Evidenz die Losung „One DRG, one price“ ausgeben." Dies ist ein Zitat aus dem folgendem PDF, welches im September 2009 von der Gesellschaft für Biomedizinische Ethik der Schweiz publiziert wurde.
Das Problem der Fairness&Equity hervorragend umschrieben: "As a consequence of these trends, resource allocation becomes less determined by a populations’ health care needs. As early experience of deprived areas in the United States indicates, activity-based resource allocation may result in the abolishment of less profitable services, including the vital accident and emergency units, while more resources are unreasonably gravitated to fewer financially attractive treatments and localities, deteriorating the principle of equity in health care (Pollock, 2005). Moreover, according to Koivasulo (2003) in recent European experience there is also little evidence that market instruments of health care provider reimbursement lead to improved and lower cost health care systems with better resource allocation. To the contrary, she finds more verification that marketisation brings new problems in terms of cost-containment and equity considerations. Light (2000), while trying to explain these faults, also argues that contractual relationships are too underdeveloped “to prevent excessive profits by selecting healthier enrollees”, whereas prices often do not reflect costs because of anti-competitive conduct by market forces through which “a great number of horizontal price-fixing, market-sharing and collective bargaining agreements” is taking place (p. 972)." Mehr ...? siehe pdf
Es existieren betreffend Finanzierung von Gesundheitswesen in Europa erhebliche Bedenken: "If the stance on common commercial policies remains unchanged, there is a high risk that European Community trade policies will compromise the capacities of Member States to ensure the financial sustainability of their health systems and social rights of their citizens. European citizens have the right to expect that decisions concerning the organisation of their health systems and the delivery of health care will be made on the basis of health policy priorities and interests, rather than on the basis of equal treatment of service providers or the priorities of commercial actors." Mehr ...? Siehe pdf
Eine Studie an 3.6 Millionen Personen, welche hospitalisiert wurden, zeigt, dass über 50% der Kosten nicht durch DRG erklärbar sind: "This analysis is based upon a decomposition of the variation in the net prices of individual patients casemix intensity indices to explain market price differentials and thus to set payment accordingly. The good news is that the standard HCFA casemix weights do an excellent job of explaining the mean values of net price from one DRG to another: As summarized above, one variable of log net price. The bad news is that the CMW is not a tremendously precise predictor of prices at the individual patient (rather than DRG-mean) level; the CMW explains only about 40% of the variation in individual patient net prices. The further news is that the usual suspects’ hospital admissions, designed to shed some light on the adequacy of simple—log of CMW—explains about 95% of the sample variation in DRG-mean—in this study, just ten of the more obvious indicators of patient illness severity—explain about 70% of the intra-DRG variation in patient prices. In other words, the basic HCFA CMW values systematically explain a fair amount of individual patient price variation, but the individual patient condition indicators described above explain, incrementally,about as much of the underlying price variation as the CMW does. Altogether, the CMW and the patient factors together jointly explain about 80% of the total variation in the log of individual patients’ net prices." Oder einfach gesagt: Casemix funktioniert als Mittelwert gut, sagt aber viel zu wenig über individuell zu erwartende Kosten aus. Mehr ...? Siehe pdf
