How to prepare hospitals for the future? : Hamburg Center for Health Economics : University of Hamburg

Hospitals can maintain or improve their quality while saving money if:

1. Pressure on emergency rooms reduced through better patient management.

2. More surgeries are transferred to the outpatient sector.

3. They merge into larger groups and pool their capacities.

1. Reforming emergency care could save €4.5 billion annually in the medium term

Photo: HCHE

Two key things need to be done to make this happen:

1. Reduction in the number of inpatients for whom outpatient care would be sufficient (€2.6 billion – 1.7 million cases).

2. Savings through improved patient management by control centers and in emergency medical services (€1.9 billion).

Photo: HCHE

On the other hand:

• Costs for higher reimbursement for 16 million existing and 1.7 million new outpatient emergencies: €1.0 billion

• Investment costs for 750 integrated emergency centers: €1.8 billion

2. How can hospitals be convinced to shift cases to ambulatory surgery?

Photo: HCHE

Distribution of inpatient and outpatient surgeries

About 40 % of all possible outpatient procedures (as defined by German law) were still performed on an inpatient basis.

Photo: HCHE

Options for policymakers

If hospitals do not shift surgeries to the outpatient sector on their own, how can policymakers exert influence?

Photo: HCHE

Expert insight

On what basis do policymakers decide which procedures can be performed on an outpatient basis?

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Outpatient index

With this model, policymakers and hospital administrators can develop targeted strategies to encourage hospitals to optimize the provision of health services, reduce unnecessary inpatient admissions, and better allocate resources to necessary inpatient treatments.

Test the Light Version

3. Mergers: quality booster and cost saver?

Photo: HCHE

Increase in mergers expected

In emergency situations such as heart attacks, it is particularly important to rely on the quality of the nearest hospital, as quick action is essential and there is no time to search for the best hospital.

Photo: HCHE

Will the quality of care change after a merger?

What we learned: Better infrastructure (e.g., cath labs) improved the quality of emergency care, even with the same staffing levels. For other procedures, such as hip and knee replacements, the quality of care remained consistently high with no deterioration.

Photo: HCHE

Seeing mergers as an opportunity

This research was supported by Deutsche Forschungsgemeinschaft (Grant No. 556603662; Esra Eren Bayindir, Reinhard Busse, and Jonas Schreyögg, co-principal investigators).