Economic Aspects of Nursing in Inpatient Naturopathy: Evidence from Germany

Article excerpt

AS PART OF THE HEALTH REFORM in the year 2000, German legislation assigned the task of introducing a new "integrated, performance-oriented and all-inclusive remuneration system" for inpatient and partial inpatient hospital services. The participants were the central asso- ciations of the official health insurance providers, the Verband der Privaten Krankenversicher- ungen (association of private hos- pital insurance providers) and the Deutsche Krankenhausgesellschaft (German hospitals association).

The system of diagnosis-relat- ed groups (DRGs), which was al- ready used internationally should serve as a basis for orientation. The German DRG system (G-DRG) was introduced in 2003. The introduction of this all-embracing hospital remuneration system based on DRGs has changed hospital routine in Germany. All cases must be coded precisely to gener- ate greater transparency and the maximum incentive for an eco- nomical provision of services. The definitive criteria for the assign- ment of a case for treatment to a diagnosis-related case group are the primary diagnosis, which is the reason for the hospitalization, secondary diagnoses and compli- cations which exist or are diag- nosed and have an influence on the therapy the duration of the stay in hospital, the procedures or operations performed in the hos- pital, and the age and sex of the patient or the weight at birth or admission in the case of prema- ture births and infants.

The DRG system in Germany is a learning system; it is updated annually in response to current developments by means of a sur- vey of treatment data from German hospitals. The purpose of the new system is to remove dysfunctional incentives, to motivate the hospi- tals to function more economical- ly to achieve more efficient hospi- tal care and, at the same time, to reduce superfluous services and increase the quality of the services provided.

The items discussed in the context of the G-DRG system include the working conditions of different professions, aspects of patient orientation, and quality as- surance. Questions about ade- quate determination of the DRG cost for very expensive services or for the costs of professional groups such as the nursing service play an increasingly important role. Those involved in nursing res- earch do not consider that the costs of nursing services are ade- quately accounted for in an all- inclusive remuneration system. As a result, there can be signifi- cant differences in the costs of nursing for the same case groups (Kahlisch, Kobold & Rau, 2004; Mowry & Korpman, 1985; Welton & Halloran, 2005).

At present, the costs of nursing in Germany are defined in terms of "nursing-relevant secondary diag- noses." However, the further devel- opment of the German-DRG system reveals that nursing diagnoses play a constantly declining role with regard to increasing severity and revenue assurance. In particular, the additional therapeutic nursing services performed, for example, by specially trained, certified nurs- es in acute hospitals focusing on naturopathy, is not adequately defined in the G-DRG system.

Inpatient Naturopathy In the German All-Inclusive Case System

The demand for complementa- ry and alternative medicine (CAM) is increasing worldwide (Bensous- san 1999; Eisenberg et al., 1998; Molassiotis et al., 2005; Yussman, Ryan, Auinger, & Weitzman 2004).

Among the German popula- tion, there is also a growing demand for the methods of classi- cal naturopathy. The range of methods covered by the term CAM is not identical with natur- opathy as practiced in Germany and the rest of Europe. German/ European naturopathy encom- passes the methods of "classical" naturopathy. It includes exercise therapy, hydro-/thermotherapy, lifestyle-regulative therapy, dietet- ic therapy, and phytotherapy. As extended naturopathic methods, classical naturopathy includes neurotherapy and derivative me- thods such as cupping or leeching. Inpatient naturopathy is currently still rare within the German health system. …