DRG and DMP - the new terms in health administration

Healthcare reform is almost in the towel, although the problem remains in practice. In addition to the political bickering of politicians, doctors, the pharmaceutical industry and health insurers, patients regularly hear terms that are difficult to understand in the ongoing discussion. Nevertheless, one will have to get used to DRG, DMP, IGeL and Co.

DRG (Diagnosis Related Groups) - Diagnosis-related case flat rates

They are the heart of the health care reform of Ulla Schmidt in the hospital sector. Instead of the daily rates, which the hospitals have negotiated so far with the health insurance companies, the clinics then receive fixed rates for a total of 661 diagnoses. This is to ensure that patients are no longer unnecessarily long in the hospital bed, because the clinic now receives a fixed price for an appendectomy.

Doctors and medical staff sometimes object because they see the quality of medical care at risk. The distinction can be summed up a bit: on the clinical side similar cases should be summarized and thus the treatment be optimized. To this end, clinicians have specific treatment plans and pathways based on a patient classification system. On the economic side, the previously divergent goals for Etrag and costs should be balanced.

DMP (Disease Management Programs) - Disease Management Program

This idea, too, comes from the USA and serves to better treat chronically ill patients. Decisive for the development of disease management programs was the realization that chronically ill patients in Germany are far too often double-checked, treated in an uncoordinated manner by GPs and specialists and neglected in psychosocial care. This is especially true for patients with diabetes (diabetes), cardiovascular disease, breast cancer, hypertension, and chronic lung disease. At the center of treatment is the family doctor, who as the coordinator monitors the individual treatment steps, passes them on to the patient and involves him as an equal partner in the treatment.

Since many chronically ill patients often suffer from several diseases, this coordination is particularly important. The term "management" should make it clear that it is not about the care of an acute case of illness, but a long-term, systematic care of patients. One of the foundations for this is evidence-based medicine.

Evidence-based medicine (EBM)

According to established procedural rules, scientific information on diagnostic or therapeutic procedures is checked for validity and clinical relevance. This is to prevent the use of ineffective or even harmful procedures. By systematically combining knowledge from medical research and clinical experience, the level of knowledge of physicians is to be continuously improved. With the help of EBM treatment guidelines are created.

RSA - risk structure compensation

The reform of the risk structure compensation in January 2002 also meant entry into the disease management programs. Until the reform of the RSA, a financial compensation within the statutory health insurance (SHI) had to ensure that health insurance funds with many young, high-income members without children in checkouts with old, low-income observers in fair competition with each other. Disease management programs take into account the duration and severity of the illness. In this way, the high costs in the treatment of the chronically ill should be distributed more equitably.

IGeL - Individual health services

IGel in practice are not an indication of a veterinarian, but on health or treatment offers that are not covered by the health insurance. Nevertheless, they must be reputable and may only be offered on the basis of the medical fee schedule. These include, for example, additional health check-ups, travel medical consultations, anti-aging cures and nutritional advice.

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