Subject(s)
Cost Control/trends , Insurance, Nursing Services/economics , National Health Programs/economics , Nurse-Patient Relations , Quality Assurance, Health Care/economics , Forecasting , Germany , Humans , Insurance, Nursing Services/trends , Job Satisfaction , Politics , Quality Assurance, Health Care/trendsSubject(s)
Insurance, Nursing Services/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Pediatric Nursing/legislation & jurisprudence , Activities of Daily Living/classification , Adolescent , Child , Child, Preschool , Disability Evaluation , Germany , Home Health Nursing/economics , Home Health Nursing/legislation & jurisprudence , Home Nursing/economics , Home Nursing/legislation & jurisprudence , Humans , Infant , Insurance, Nursing Services/economics , National Health Programs/economics , Pediatric Nursing/economicsSubject(s)
Adolescent Health Services/economics , Child Health Services/economics , Financing, Government/economics , National Health Programs/economics , Refugees/statistics & numerical data , Adolescent , Child , Child, Preschool , Costs and Cost Analysis/economics , Emergency Service, Hospital/economics , Financial Management, Hospital/economics , Financing, Personal/economics , Germany , Health Services Accessibility/economics , Health Services Needs and Demand/economics , Humans , Infant , Insurance, Nursing Services/economics , Pediatric Nursing/economics , Poverty/economics , Taxes/economicsABSTRACT
BACKGROUND: The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. AIM: The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. METHOD: The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. RESULTS: The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. CONCLUSIONS: The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.
Subject(s)
Clinical Nursing Research , Diagnosis-Related Groups/economics , Diagnosis-Related Groups/organization & administration , Financing, Government/economics , Financing, Government/organization & administration , Insurance, Nursing Services/economics , National Health Programs/economics , National Health Programs/organization & administration , Adult , Attitude of Health Personnel , Cross-Sectional Studies , Female , Humans , Job Satisfaction , Male , Middle Aged , Nursing Administration Research , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/organization & administration , Surveys and Questionnaires , SwitzerlandSubject(s)
Eligibility Determination/economics , Eligibility Determination/legislation & jurisprudence , Insurance, Nursing Services/economics , Insurance, Nursing Services/statistics & numerical data , National Health Programs/economics , National Health Programs/legislation & jurisprudence , Activities of Daily Living/classification , Adolescent , Aged , Child , Child, Preschool , Disability Evaluation , Germany , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Home Care Services/economics , Home Care Services/legislation & jurisprudence , Humans , Infant , Nursing Homes/economics , Nursing Homes/legislation & jurisprudence , Reimbursement Mechanisms/economics , Reimbursement Mechanisms/legislation & jurisprudenceSubject(s)
Home Care Services/economics , Home Care Services/legislation & jurisprudence , Insurance, Nursing Services/economics , Insurance, Nursing Services/legislation & jurisprudence , National Health Programs/economics , National Health Programs/legislation & jurisprudence , Nursing, Private Duty/economics , Nursing, Private Duty/legislation & jurisprudence , Reimbursement Mechanisms/economics , Reimbursement Mechanisms/legislation & jurisprudence , Contract Services/economics , Contract Services/legislation & jurisprudence , Fee Schedules/economics , Fee Schedules/legislation & jurisprudence , Germany , Humans , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/legislation & jurisprudence , Societies, NursingSubject(s)
Insurance, Nursing Services/trends , National Health Programs/trends , Societies, Nursing/trends , Forecasting , Health Services Needs and Demand/economics , Health Services Needs and Demand/trends , Humans , Insurance, Nursing Services/economics , National Health Programs/economics , SwitzerlandSubject(s)
Diagnosis-Related Groups/economics , Insurance, Nursing Services/economics , Length of Stay/economics , National Health Programs/economics , Reimbursement Mechanisms/economics , Cost Allocation/economics , Cost Allocation/trends , Cost Control/economics , Cost Control/trends , Cost-Benefit Analysis/economics , Cost-Benefit Analysis/trends , Forecasting , Humans , SwitzerlandSubject(s)
Adult Children , Caregivers/economics , Caregivers/legislation & jurisprudence , Financing, Personal/legislation & jurisprudence , Homes for the Aged/economics , Homes for the Aged/legislation & jurisprudence , Insurance, Nursing Services/economics , Insurance, Nursing Services/legislation & jurisprudence , National Health Programs/economics , National Health Programs/legislation & jurisprudence , Nursing Homes/economics , Nursing Homes/legislation & jurisprudence , Aged , Germany , HumansABSTRACT
Due to demographic and social developments nursing service will continueto be a growth industry in the long run. The requirement for this is the political volition of a sufficient funding. A minimum wage in nursing service tends to increase prices of the offered services. Stated justifications for a minimum wage are wage dumping protection (inter alia against the background of the upcoming opening of the single market in 2011) as well as raising rivals' costs. Protection is focused on the 266,000 non-skilled workers in basic care owing to the strong tightening of the labour market for caregivers. Operative minimum wages will lead to adjustments by optimising operations, intensification of work, and rationalisation of workflow by increased employment of capital as well as technical substitution of relatively expensive non-skilled workers. In addition there will be increased pressure on prices for nursing services and private co-payments. There will be an increased supply and demand for illegal services. Suppliers who had been tied to collective contracts so far will achieve a relative advantage in competition.
Subject(s)
Financing, Government/economics , Insurance, Nursing Services/economics , National Health Programs/economics , Nursing Staff/economics , Salaries and Fringe Benefits/legislation & jurisprudence , Costs and Cost Analysis , Financing, Personal/economics , Forecasting , Germany , Home Care Services/economics , Humans , Population Dynamics , Quality Assurance, Health Care/economicsSubject(s)
Caregivers/economics , Caregivers/trends , Home Care Services/economics , Home Care Services/trends , Population Dynamics , Adult , Aged , Aged, 80 and over , Caregivers/psychology , Costs and Cost Analysis , Female , Forecasting , Germany , Health Services Needs and Demand/trends , Home Care Services/supply & distribution , Humans , Insurance, Nursing Services/economics , Insurance, Nursing Services/trends , Male , Middle Aged , Quality of Life/psychology , Stress, Psychological/complicationsSubject(s)
Health Care Reform/legislation & jurisprudence , Insurance, Nursing Services/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Aged , Cost Control/legislation & jurisprudence , Disability Evaluation , Eligibility Determination/economics , Eligibility Determination/legislation & jurisprudence , Germany , Health Care Reform/economics , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Homes for the Aged/economics , Homes for the Aged/legislation & jurisprudence , Humans , Insurance, Nursing Services/economics , National Health Programs/economics , Nursing Homes/economics , Nursing Homes/legislation & jurisprudence , Patient Care Team/economics , Patient Care Team/legislation & jurisprudenceSubject(s)
Caregivers/economics , Caregivers/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Home Nursing/economics , Home Nursing/legislation & jurisprudence , Insurance, Nursing Services/legislation & jurisprudence , Liver Transplantation/nursing , Public Assistance/economics , Public Assistance/legislation & jurisprudence , Eligibility Determination/legislation & jurisprudence , Female , Germany , Humans , Infant , Insurance, Nursing Services/economicsABSTRACT
For most of the existing German Diagnosis Related Groups (G-DRG) the German generalised compensation system for medical services in hospitals does not distinguish between children and adults. There is a risk of the cost of high-maintenance paediatric patients not being covered. This problem is tried to be solved by implementing a split based on the patient's age. Thus children under the age of one year will be classified to a different DRG than older patients with the same diagnosis. A study of working time combined with an analysis of the so-called "Pflegepersonalregelung-Minuten" carried out by the Ernst-Moritz-Arndt University of Greifswald exemplarily shows the different intenseness of care between paediatric and adult patients. Furthermore, the different intenseness of care correlates with the labour cost of the university hospital and shows the extensions of the shortfall for the most profitable DRG based on guidelines of the "Institut für das Entgeltsystem im Krankenhaus" (Institute for the compensation system in hospitals, InEK). Last but not least it discusses if the age-splitting planned for the 2008 DRG-Catalogue might improve the financial situation. Moreover the authors point out possibilities for a proper compensation for paediatrics in the G-DRG system.