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Schildmann, E.* ; Hodiamont, F.* ; Leidl, R. ; Maier, B.O.* ; Bausewein, C.*

Which reimbursement system fits inpatient palliative care? A qualitative interview study on clinicians' and financing experts' experiences and views.

J. Palliat. Med 22, 1378-1385 (2019)
Verlagsversion DOI
Open Access Green möglich sobald Postprint bei der ZB eingereicht worden ist.
Context: Internationally, a variety of reimbursement systems exists for palliative care (PC). In Germany, PC units (PCUs) may choose between per-diem rates and diagnosis-related groups (DRGs). Both systems are controversially discussed. Objectives: To explore the experiences and views of German PCU clinicians and experts for PCU financing regarding per-diem rates and DRGs as reimbursement systems with a focus on (1) cost coverage, (2) strengths and weaknesses of both financing systems, and (3) options for further development of funding PCUs. Design: Qualitative semistructured interviews with PCU clinicians and experts for PCU financing, analyzed by thematic analysis using the Framework approach. Setting/Subjects/Measurements: Ten clinicians and 13 experts for financing were interviewed June-October 2015 on both reimbursement systems for PCU. Results: Interviewees had divergent experiences with both reimbursement systems regarding cost coverage. A described strength of per-diem rates was the perceived possibility of individual care without direct financial pressure. The nationwide variation of per-diem rates and the lack of quality standards were named as weaknesses. DRGs were criticized for incentives perceived as perverse and inadequate representation of PC-specific procedures. However, the quality standards for PCUs required within the German DRG system were described as important strength. Suggestions for improvement of the funding system pointed toward a combination of per-diem rates with a grading according to disease severity/complexity of care. Conclusions: Expert opinions suggest that neither current DRGs nor per-diem rates are ideal for funding of PCUs. Suggested improvements regarding adequate funding of PCUs resemble and supplement international developments.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter Diagnosis-related Groups (drgs) ; Economics ; Financing ; Funding ; Palliative Care ; Per-diem Rates ; Qualitative Research ; Reimbursement; Australian Casemix Classification; Lessons; Costs
ISSN (print) / ISBN 1096-6218
e-ISSN 1557-7740
Zeitschrift Journal of Palliative Medicine
Quellenangaben Band: 22, Heft: 11, Seiten: 1378-1385 Artikelnummer: , Supplement: ,
Verlag Mary Ann Liebert
Verlagsort Larchmont, NY