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Managing Hospital Volumes: Germany and Experiences from OECD Countries


  • Ankit Kumar


  • Michael Schoenstein



To help inform a conference organised by the Germany Ministry of Health (BMG) and the OECD on ‘Managing Hospital Volumes’ on the 11th April 2013, the OECD Secretariat produced this paper giving an international perspective on Germany’s situation and the current policy debate. It provides a number of observations about the structure and financing of hospitals in Germany. It begins by arguing that Germany has a more open-ended approach to the financing of hospital services and weaker controls over the hospital budget than in many other OECD countries. In large part this reflects that DRGs in Germany are almost strictly used for pricing, whereas other countries use DRGs as one of many tools they have to influence hospital budgets. This is compounded by a situation where State governments do not have an incentive to rationalise hospital capacity where this may be desirable. Finally, the paper argues that the vast array of quality information available in Germany ought to be used to better direct financing. Afin d’apporter des informations à l’appui de la conférence organisée le 11 avril 2013 par le ministère allemand de la Santé (BMG) et l’OCDE sur le thème de la « Gestion des volumes d’activité des hôpitaux », le Secrétariat de l’OCDE a élaboré ce document, qui permet d’aborder la situation de l’Allemagne et le débat en cours selon une perspective internationale. Ce texte livre un certain nombre d’observations concernant la structure et le financement des hôpitaux allemands. Il montre dans un premier temps que l’Allemagne a du financement des services hospitaliers une approche plus ouverte que de nombreux autres pays de l’OCDE, et que le budget des hôpitaux y est plus faiblement contrôlé. Cela tient en grande partie au fait que la tarification des services hospitaliers repose en Allemagne presque exclusivement sur les groupes homogènes de malades (GHM), alors que d’autres pays s’en servent plutôt – avec un grand nombre d’autres outils – pour contrôler le budget des hôpitaux. Cette situation est renforcée par le fait que les autorités des Länder ne sont pas incitées à rationaliser la capacité du secteur hospitalier, alors que cela pourrait être souhaitable. Enfin, le document fait valoir que les nombreuses informations disponibles en Allemagne sur la qualité des soins devraient contribuer à une meilleure affectation des financements.

Suggested Citation

  • Ankit Kumar & Michael Schoenstein, 2013. "Managing Hospital Volumes: Germany and Experiences from OECD Countries," OECD Health Working Papers 64, OECD Publishing.
  • Handle: RePEc:oec:elsaad:64-en
    DOI: 10.1787/5k3xwtg2szzr-en

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    Cited by:

    1. Hentschker, C. & Wübker, A., 2016. "The impact of technology diffusion in health care markets - Evidence from heart attack treatment," Health, Econometrics and Data Group (HEDG) Working Papers 16/29, HEDG, c/o Department of Economics, University of York.
    2. Nico Pestel & Florian Wozny, 2019. "Low Emission Zones for Better Health: Evidence from German Hospitals," CINCH Working Paper Series 1904, Universitaet Duisburg-Essen, Competent in Competition and Health.
    3. Natalie Baier & Lisa-Marie Sax & Leonie Sundmacher, 2019. "Trends and regional variation in rates of orthopaedic surgery in Germany: the impact of competition," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 163-174, February.
    4. Corinna Hentschker & Ansgar Wuebker, 2018. "Quasi-experimental evidence on the effectiveness of heart attack treatment in Germany," CINCH Working Paper Series 1804, Universitaet Duisburg-Essen, Competent in Competition and Health.
    5. Pross, Christoph & Busse, Reinhard & Geissler, Alexander, 2017. "Hospital quality variation matters – A time-trend and cross-section analysis of outcomes in German hospitals from 2006 to 2014," Health Policy, Elsevier, vol. 121(8), pages 842-852.
    6. Corinna Hentschker & Roman Mennicken, 2015. "The Volume‐Outcome Relationship and Minimum Volume Standards – Empirical Evidence for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 644-658, June.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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