Outpatient care: New perspectives

Low rate of outpatient surgeries in Germany

The list of possible outpatient surgeries keeps growing, but Germany is still one of the European countries with the lowest rate of these procedures.

Central problem: Different payments

A key reason lies in the different reimbursement systems for outpatient and inpatient services. While inpatient procedures were better reimbursed via DRGs, outpatient surgeries under the EBM were often not cost-covering. This resulted in a lack of economic incentive for many practices.

Recommendations

Hybrid DRGs should be recalculated based on real data collected and levels of complexity. It is essential to differentiate between simple and complex cases with high care needs. Transparent calculations are required, broken down by medical specialties such as surgery or anesthesiology, as well as non-medical professions.

General rule

The physician decides on the treatment. The patient decides on any services to be paid privately, e.g., ultrasound scans or intraocular pressure measurement.

In an experiment, we investigated what happens when patients purchase or reject an additional service.

Results of the experiment

The study shows that purchasing additional services does not improve the quality of treatment.

However, if an additional service is rejected, the quality of treatment measurably decreases on average.

Learnings

Patients cannot buy better treatment, but quality of treatment is lower when the doctor is aware they did not purchase additional services.

Greater awareness that unconscious reactions to patient decisions can influence treatment: clear communication would be helpful when dealing with additional services.

Time and cost savings

A structured exchange of information between general practitioners, specialists and patients improves diagnostics, avoids double testings and saves time and costs.

Experiment: Financial incentives

In an experiment, we researched the performance of physicians based on compensation for providing information.

Without additional compensation, information is often only shared to a limited extent. Even small bonus payments can increase the quantity and, in some cases, the quality of the information provided.

Further insights

It matters who benefits from the information. In one setting, GPs are more likely to share high-quality information if the recipient is a patient rather than a specialist. Additionally, a budget-neutral introduction of a bonus is particularly cost-effective, ensuring better outcomes without increasing overall spending.