On 6 December 2022, the Government Commission for a Modern and Needs-Based Hospital Sector submitted its proposals for a reform of the hospital remuneration system. According to the Minister of Health, the current remuneration system based on caseloads incentivizes hospitals to treat as many cases as possible at the lowest possible cost [1]. The commission proposes that the treatment of patients in hospitals should be based more on medical and less on economic criteria. Therefore, the Commission proposes a remuneration system depending on three new criteria: provision of services, levels of care, and service groups [2]:
1) Compensation for upfront services
2) Definition of hospital care in three levels
Hospitals are to be classified into three care levels and funded accordingly:
- Primary care – basic: medical and nursing care, such as basic surgeries and emergencies.
- Regular and specialized care: hospitals that offer additional services compared to basic care.
- Maximum care: for example, university hospitals.
The first-level hospitals are further divided into two groups: 1) hospitals that ensure emergency care (Level 1n) and 2) those that offer integrated outpatient/inpatient care (Level 1i).
3) Introduction of defined service groups
Hospitals are currently treating certain cases all too often without the appropriate personnel and technical equipment, such as heart attacks without a left heart catheter, strokes without a stroke unit, or oncological diseases without a certified cancer centre. Therefore, departments are to be assigned to more precisely defined service groups.
The Commission recommended a gradual implementation of the regulations over a transitional period of five years [1].