Zusammenfassung
Die Gestaltung von Vergütungssystemen für die Leistungserbringer ist ein wesentliches Steuerungsinstrument von Managed Care. Zum besseren Verständnis dieses Instruments und seiner Wirkungsweise werden zunächst die Grundlagen von Vergütungssystemen ganz allgemein dargestellt (s. Abbildung 2‐1), um dann genauer auf die Vergütungssysteme in Managed Care einzugehen.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Literatur
Amelung, V. et al. (2009), Monetäre Anreize gezielt einsetzen- das Konzept qualitätsorientierter Vergütung, in: MVF 06/2009, 2. Jahrgang, S. 25–30
Amelung, V. E./Janus, K. (2005), Budgetverteilung in der integrierten Versorgung – Welche Modelle haben eine Chance?, in: Hellmann W (Hrsg.), Handbuch integrierte Versorgung. 3. Erg. Lfg. 4/05, Economica Heidelberg, S. 1–20
Amelung, V. E./Voss, H./Janus, K. (2005), Ökonomische Anreize in integrierten Versorgungssystemen – Grundlage für Nachhaltigkeit, Zufriedenheit und Motivation, in: Badura, B./Iseringhausen, O., Wege aus der Krise der Versorgungssituation – Beiträge aus der Versorgungsforschung, Hans Huber, Bern, S. 115–131
Amelung, V./Zahn, T. (2009,: Pay-for-Performance (P4P) – Der Business Case für Qualität? (unveröffentlichte Studie), Berlin
Aventis Pharmaceuticals (2002), Managed Care Digest Series, HMO-PPO/Medicare- Medicaid Digest, Bridgewater/NJ
Baker, G. /Delbanco, S. (2007), Pay for Performance: National Perspepctive. 2006 Longitudinal Survey Results with 2007 Market Updates, Med- Vantage Inc.
Biermann A./Clark, J. (2007), Performance Measurement and equity, in: BMJ; 334, S. 1333–1334
Birkmeyer, N./Birkmeyer, J. (2006), Strategies for improving surgical quality – should payers rewards excellence or effort?, New England Journal of Medicine, 354 (8), S. 864– 870
Böcker, K. et al. (2001), Diagnosis Related Groups – Grundstein für ein neues Abrechnungssystem der Krankenhäuser und Krankenkassen. Implikationen und Herausforderungen, in: Salfeld, R./Wettke, J. (Hrsg.), Die Zukunft des deutschen Gesundheitswesens. Perspektiven und Konzepte. Springer, Heidelberg. S. 49–77
Bodenheimer, T. S./Grumbach, K. (1994), Reimbursing Physicians and Hospitals, in: JAMA, 272, S. 971–977
Bodenheimer, T. S./Grumbach, K. (1996), Capitation or Decapitation, in: JAMA, 276, S. 1025–1031
Bodenheimer, T. S./Grumbach, K. (2009), Understanding Health Policy, A Clinical Aproach, 5. Auflage, MCGraw-Hill Medical
Cacace, M. (2010), Das Gesundheitssystem der USA: Governance-Strukturen staatlicher und privater Akteure, Campus, Frankfurt a.M.
Cannon, M. F. (2006), Pay for Performance: Is Medicare a Good Candidate?, in: Yale Journal of Health Policy, Law, and Ethics 2007 Winter; 7 (1), S. 1–38
Carter, M. G. et al. (1994), Use of Diagnosis-Related Groups by Non-Medicare Payers, in: Health Care Financing Review, 16, S. 127–159
Casale, A. S./Paulus, R. A./Selna, M. J./Doll, M. C./Bothe, A. E./McKinley, K. E./Berry, S. A./Davis, D. E./Gilfillan, R.J ./Hamory, B. H./Steele, G. D. (2007), “ProvenCareSM”: A Provider-Driven Pay-for-Performance Program for Acute Episodic Cardiac Surgical Care, in: Annals of Surgery, Volume 246 (4) , S. 613–623
Casto, A./Layman, E. (2006), Principles of healthcare reimbursement, American Health Information Management Association, Chicago
Chernew, M. (2010), Bundled Payment Systems: Can They be More Successful this Time, in: Health Services Research 45 (5), Part I, October 2010
Cleverley, W. O./Song, P. ./Cleverley, J. O. (2010), Essentials of Health Care Finance, 7. Auflage, Sudbury, MA
Committee on Redesigning Health Insurance Performance Measures (2006), Rewarding provider performance: Aligning incentives in medicare, Institute of Medicine Washington, D. C.
Conrad, D. A. et al. (1998), Primary Care Physician Compensation Method in Medical Groups, in: JAMA, 279, S. 853–858
Conzen, C./Freund, J./Overlander, G. (2009), Pflegemanagement heute, Okonomie Personal Qualität: verantworten und organisieren, München
Cromwell, J. et al. (2011), Pay for Performance in Health Care: Methods and Approaches. RTI Press Publication No. BK-0002-1103. Research Triangle Park, NC: RTI Press
Cutler, D. M. et al. (2004), The Role of Information in Medical Markets: An Analysis of Publicly Report Outcomes in Cardiac Surgery. In: The American Economic Review, Vol. 94 (2), S. 342–346
Damberg, C./Raube, K./Teleki, S./dela Cruz, E. (2009), Taking Stock of Pay-for- Performance: A Candid Assessment from the Front Lines, Health Affairs, Mar-Apr, 28(2), S. 517–25
Damberg, C./Raube, K./Williams, T./Shortell, S. (2005), Paying for Performance: Implementing a Statewide Project in California, Q Manage Healthcare, Vol. 14(2), S. 66–79
Dirschedl, P./Reichle, M./Röther, M. (2003), Modellprojekt Kodierqualität, In: Gesundheitswesen 2003, 65(1), S. 1–7
Doran, T./Fullwood, C./Gravelle, H./Reeves, D./Konstopantelis, E./Hiroe, U./ Roland, M. (2006), Pay-for-performance programs in family practices in the United Kingdom, New England Journal of Medicine, 355 (4), S. 375–384
Dudley, A. R. (2005), Pay-for-performance research: How to learn what clinicians and policy makers need to know, Journal of American Medical Association, 294 (14), S. 1821–1823
Düllings, J. et al. (2001), Praxishandbuch. Einführung der DRGs in Deutschland, Decker, Heidelberg
Emmert, M. (2008), Pay for Performance (P4P) im Gesundheitswesen, Ein Ansatz zur Verbesserung der Gesundheitsversorgung?, Burgdorf
Emmert, M./ Schöffski, O. (2007), Public Reporting des kalifornischen „Pay for Performance” der Integrated Healthcare Association (IHA), in: Gesundheitswesen; 69, S. 438–447
Faber, M. et al. (2009), Public Reporting in Health Care: How Do Consumers Use Quality-of-Care Information? A Systematic Review, in: Med Care 2009; 47, S. 1–8
Fetter, R. B. et al. (1980), Case Mix Definition by Diagnosis-Related Groups, in: Medical Care, 18, Supplement, S. 1–53
Fischer, W. (2004), DRG-Entwicklungsperspektiven, in: Klauber, J./Robra, B.P./Schellschmidt, H. (Hrsg.) (2004), Krankenhaus-Report 2003 – Schwerpunkt: GDRG im Jahre 1, Schattauer, Stuttgart, S. 3–21
Fowles, J. B. et al. (1996), Taking Health Status into Account When Setting Capitation rates: a Comparison of Risk-adjustment Methods, in: JAMA 1996, 276, S. 1316–132
Frisina, L./Cacace, M. (2009), Chapter XII: DRGs and the Professional Independence of Physicians. In: Dwivedi, Ashish (ed.): Handbook of Research on IT Management and Clinical Data Administration in Healthcare, Volume I, Hershey, PA: IGI Global, S. 173–191
Fung et. al. (2008), The Evidence that Publishing Patient Care Performance Data Improves Quality of Care, in: Ann Intern Med; 148, S. 111–123
Gallagher, Th. et al. (2001), Patient's Attitudes Toward Cost Control Bonuses For Managed Care Physicians, in: Health Affairs 20(2), S. 186–192
Gapenski, L. C. (1998), The Financial Risk to Hospitals Inherent in DRG, Per Diem, and Capitation Reimbursement Methodologies, in: Journal of Health Care Management, 43, S. 323–337
Gemmil, M. (2007), Pay-for-Performance in the US: What lessons for Europe?, in: Eurohealth, Vol. 13; No. 4, S. 21–23
Geraedts, M. (2006), Qualitätsberichte deutscher Krankenhäuser und Qualitätsvergleiche von Einrichtungen des Gesundheitswesens aus Versichertensicht, In: Gesundheitsmonitor, Düsseldorf, Bertelsmann-Stiftung
Geraedts, M. et al. (2009), Public Reporting- Formen und Effekte öffentlicher Qualitätsberichterstattung, in: Dtsch Med Wochenschr; 134; S. 232–233
GKV Spitzenverband (2011) www.gkvspitzenverband.de/Inhalte_der_Qualitaetsberichte.gkvnet, abgerufen März 2011
Gold, M. et al. (1995), A National Survey of the Arrangements Managed Care Plans Make with Physicians, in: The New England Journal of Medicine, 333, S. 1678–83
Goozner, M. (2011), United Healthcare, Five Oncology Practices Try Bundled Payments, JNCI Vol. 103, Issue 1
Gosden, T./Forland, F./Kristiansen, I./Sutton, M./Leese, B./Guiffrida, A. (2002), Capitation, salary, fee-for-service and the mixed systems of payment: Effects on the behaviour of primary care physicians, The Cochrane Library
Grumbach, K. et al. (1998), Primary Care Physicians’ Experience of Financial Incentives in Managed-Care Systems, in: The New England Journal of Medicine, 339, 1516–1521
Guterman, S./Davis, K./ Schoenbaum, S./ Shih, A. (2009), Using Medicare Payment Policy To Transform The Health System: A Framework For Improving Performance, in: Health Affairs 28, no. 2, S. w238–w250 (published online 27 January 2009)
Günster, Ch./Mansky, Th./Repschläger, U. (2004), Das deutsche DRG-Entgeltsystem in: Klauber, J./Robra, B.-P./Schellschmidt, H. (Hrsg.) (2004), Krankenhaus-Report 2003 – Schwerpunkt: G-DRG im Jahre 1, Schattauer, Stuttgart, S. 43–69
Hanchak, N. A. et al. (1996), U. S. Healthcare's Quality-Based Compensation Model, in: Health Care Financing Review, 17, S. 143–159
Hibbard, J. H. (2003), Does Publicizing Hospital Performance Stimulate Quality Improvements Efforts? in: Health Affairs; Vol. 22, Nr. 2, S. 84–94
Hsia, D. C. et al. (1992), Medicare Reimbursement Accuracy under the Prospective Payment System, 1985–1988, in: JAMA, 268, S. 896–99
Integrated Healthcare Association (2011), 2011 P4P Measurement Set, unter: www.iha.org/pdfs_documents/p4p_california/ApprovedMY2011MeasureSet111610_OnlinePDF.pdf, Zugriff 12.06.2011
Integrated Healthcare Association (2010), Transparency Report 2010-Health Plan Payouts, www.iha.org/pdfs_documents/p4p_california/MY2009TransparencyReport_OnlinePDF.pdf, Zugriff 12.06.2011
Integrated Healthcare Association (2009), Transparency Report on 2008 Health Plan Payouts, www.iha.org/transpf/2008%20Transparency%20Report_OnlinePDF.pdf, Zugriff 20.06.2009
Integrated Healthcare Association (2006), Advancing Quality through Collaboration: The California Pay For Performance Program, A Report on the first Five Years and a Strategic Plan for the Next Five Years, February 2006, S. 1–32
Institut of Medicine (IOM) (2001), Crossing the Quality Chasm: A New Health System for the 21st Century, Washington D.C., National Academies Press
Institut of Medicine (IOM) (2006a), Rewarding Provider Performance, Aligning Incentives in Medicare, Washington D.C., National Academies Press
Institut of Medicine (IOM) (2006b), Performance Measurement: Accelerating Improvement (Pathways to Quality Health Care), Washington D.C., National Academies Press
Janus, K. (2003), Managing Health Care in Private Organizations. Transaction Costs, Cooperation and Modes of Organization in the Value Chain, Peter Lang, Frankfurt am Main
Janus, K./Amelung, V. E. (2004), Integrierte Versorgung im Gesundheitswesen – Anreizorientierte Vergütungssysteme für Ärzte, Zeitschrift für Organisation; 73 (6), S. 304–311
Klauber, J./Robra, B.-P./Schellschmidt, H. (2004), Krankenhaus-Report 2003 – Schwerpunkt: G-DRG im Jahre 1, Stuttgart, New York
Knight, W. (1998), Managed Care. What It Is and How It Works, Aspen, Gaithersburg
Kongstvedt, P. R. (2001a), Compensation of Primary Care Physicians in Open Panel Plans, in: Kongstvedt, P. R. (Hrsg.), The Managed Health Care Handbook, Gaithersburg, S. 120–146
Kongstvedt, P. R. (2001b), Negotiating and Contracting with Hospitals and Institutions, in: Kongstvedt, P. R. (Hrsg.), The Managed Health Care Handbook, Aspen, Gaithersburg, S. 202–214
Kongstvedt, P. R. (2001c), Non-Utilization-Based Incentive Compensation for Physicians, in: Kongstvedt, P. R. (Hrsg.), The Managed Health Care Handbook, Aspen, Gaithersburg, S. 166–175
Kongstvedt, P. R. (2007), Essentials of managed Health Care, 5.Auflage, Sudbury, MA
Kötter, T. et al. (2011), Die Etwicklung von Qualitätsindikatoren – Hintergrund, Methoden und Probleme, in: Z. Evid. Fortbild. Qual. Gesundh.wesen; 105, S. 7–12
Lee, T. H. (2007), Pay for Performance, Version 2.0?, in: The New England Journal of Medicine 357 (6), S. 531–533
Lee, M. et al. (2010), A decision support System for diagnosis related groups coding, In: Expert Systems with Applications, Vol. 38, Issue 4, S. 3626–3631
Lindenauer, P. K. et al. (2007), Public Reporting und Pay for Performance in Hospital Quality Improvement, in: N Engl J Med 2007; 356; S. 486–496
Mannion, R./Davies, H. (2008), Payment for performance in health care, in: British Medical Journal; Vol. 336, S. 306–308
Marshall et al. (2004), How do we maximize the impact of the public reporting of quality of care?, in: International Journal for Quality in Health Care; Vol. 16,S. i57–i63
Mechanic, R. E./Altman, S. H. (2009), Payment Reform Options: Episode Payment Is A Good Place To Start, in: Health Affairs 28, no. 2, S. w262–w271 (published online 27 January 2009)
Qaseem, A. (2010): Pay for Performance Through the Lens of Medical Professionalism, in: Annals of Internal Medicine, 152, S. 366–369
Rau, F./Roeder, N./Hensen, P. (2009), Auswirkungen der DRG-Einführung in Deutschland, Standortbestimmung und Perspektiven, Stuttgart
Robinson, J. C. (2001), The End of Managed Care, in: JAMA 285 (20), S. 2622–2628
Robinson, J. C./Casalino, LP (2001), Reevaluation of Capitation Contracting in New York And California, in: Health Affairs, July/August 2001, S. 11–19
Rosenthal, M. B. (2008), Beyond Pay for Performance — Emerging Models of Provider- Payment Reform, in: The New England Journal of Medicine 359 (12), 1197–1200
Rosenthal, M. / Dudley, R. (2007), Pay-for-Performance, Will the Latest Trend Improve Care?, in: JAMA; Vol. 297, No. 7, S. 740–743
Sanofi Aventis (2010), Managed Care Digest Series – HMO-PPO Digest for 2010–11, Bridgewater/NJ
Sauerland, D./Wübker, A. (2008), Wie Qualitätsinformationen die Krankenhauswahl beeinflussen- eine empirische Untersuchung, Diskussionspapier Nr. 15, www.akad.de/fileadmin/akad.de/assets/PDF/WHL_Diskussionspapiere/WHL_Diskussionspapier_Nr_15_OnlinePDF.pdf
Schaeffer, D. (2006), Bedarf an Patienteninformationen über das Krankenhaus, Eine Literaturanalyse, Bertelsmann-Stiftung, Gütersloh
Schauffler, H. H./Brown, C./Milstein, A. (1999), Raising the Bar: The Use of Performance Guarantees by the Pacific Business Group on Health, in: Health Affairs 18 (2), S. 134–142
Schneider E. C. et al. (1998), Use of public performance reports. A survey of patients undergoinig cardiac surgery, in: J Am Med Assoc; 279; S. 1638–1642
Schwappach, D. L. B./Schubert, H. J. (2007), Offenlegen oder nicht? Chancen und Risiken der Veröffentlichung von medizinischen Qualitätsvergleichen, in: Dtsch Med Wochenschr ; 132; S. 2637–2642
Schwartz, L. M. (2005), How do elderly patients decide where to go for major surgery? Telephone interview survey, in: British Medical Journal, 331:821
Scott, I. A. / Ward, M. (2006), Public Reporting of Hospital outcomes based on administrative data: risks and opportunities, in: MJA 2006;184, S. 571–575
Smith, P. (1995), On the unintended consequences of publishing performance data in the public sector, in: Int. J Pub Admin; 18, S. 277–310
Stearns, S. C. et al. (1992), Physicians Responses to Fee-for-service and Capitation Payment, in: Inquiry, 29, S. 416–425
Sumner, A. T./Moreland, C. C. (1995), The potential impact of diagnosis related group medical management on hospital Utilization and profitability, in: Health Care Managed Review, 20, S. 92–100
Tanenbaum, S. J. (2009), Pay for Performance in Medicare: Evidentiary Irony and the Politics of Value, in: Journal of Health Politics, Policy and Law; Vol 34, S. 717–746
Teleki, S./Damberg, L./Pham, C./Berry, H. (2006), Will financial incentives stimulate quality improvement? Reactions from frontline physicians, American Journal of Medical Quality, 21(6), S. 367–374
Underwood, H. (2007), Pay for Performance: Value-Based Purchasing in Healthcare, Presentation Health Spring Meeting- Session 25
Vaiana, M. E./McGlynn, E. A. (2002), What cognitive science tells us about the design of reports for consumers. in: Med Care Res Rev 2002, 59; S. 3–35
Van Herck, P. et al. (2010), Systematic Review: Effects, design choices, and context of pay-for-performance in health care, in: BMC Health Service Research, 10:247
Webster, L. et al. (2007), Financal Management, 3. Auflage, Chicago
Young, W. W. (1991), Patient Management Categories, in: Neubauer, G./Sieben, G. (Hrsg.), Alternative Entgeltverfahren in der Krankenhausversorgung, Bleicher, Gerlingen
Rights and permissions
Copyright information
© 2012 Gabler Verlag | Springer Fachmedien Wiesbaden GmbH
About this chapter
Cite this chapter
Amelung, V. (2012). Vergütungssysteme. In: Managed Care. Gabler Verlag, Wiesbaden. https://doi.org/10.1007/978-3-8349-7129-6_10
Download citation
DOI: https://doi.org/10.1007/978-3-8349-7129-6_10
Publisher Name: Gabler Verlag, Wiesbaden
Print ISBN: 978-3-8349-3359-1
Online ISBN: 978-3-8349-7129-6
eBook Packages: Business and Economics (German Language)