Kliniken klagen über Fallpauschale

Patienten, die länger als normal im Krankenhaus verbringen, werden dann zum finanziellen Problem für die Kliniken, wenn sie nur nach einer normalen Fallpauschaule abgerechnet werden können. Für sehr viele Klinikbehandlungen und Operationen ist festgelegt, wie viel die Krankenhäuser für den jeweiligen Fall abrechnen können. Diese Behandlungspauschale wird für Kliniken zum Problem, die häufig sehr schwierige Fälle haben.

Kliniken klagen über Fallpauschale
Kliniken klagen über Fallpauschale

Die Logik der Fallpauschale ist im Krankenhaus genauso üblich wie bei der Autoreparatur. Bezahlt wird nicht nach dem individuellen Aufwand für den einzelnen Vorgang, sondern es wird auch im Einzelfall eine Pauschale als Vergütung fällig. Dass soll die Autowerkstatten genau wie die Krankenhäuser vergleichbar machen. Motiviert durch die Fallpauschale soll auch der Aufenthalt in der Werkstatt bzw. in der Klinik verkürzt werden, denn man hat keinen wirtschaftlichen Vorteil davon, die Reparatur bzw. die Behandlung in die Länge zu ziehen.

Deutschlands Uni-Kliniken haben aber ein Problem mit den Fallpauschalen. Sie werden dann zum finanziellen Risiko, wenn es um schwierige Behandlungen gehe, die keinen typischen Verläufen folge, wie man sie eher in die Hochleistungs-Krankenhäuser der Universitäten beobachten könne. Fallpauschalen seien gut für bei üblichen Krankheiten mit kurzer oder mittlerer Aufenthaltsdauer in der Klinik. Doch man hätte häufig viele komplizierte Behandlungsfälle, die zu einem hohen Kostenrisiko werden können, weil die Betroffenen deutlich länger und häufiger behandelt werden müssen, als man dies nach den Fallpauschalen erwarten kann.

Diese Feststellungen sind aus der Sicht von Kliniken, die besonders häufig schwere Fälle behandeln müssen, nachvollziehbar. Aber man kann dies auch als Kritik an der Konstruktion und der Höhe der Fallpauschalen verstehen. Denn dieses System der Fallpauschalen macht nur Sinn, wenn es viele Fälle gibt, bei denen die Fallpauschale einen Mehrerlös über die Kosten erbringt. Diese Mehrerlöse müssen so hoch sein, dass die Kosten für schwere Fälle außerhalb der Normbehandlung querfinanziert werden. Nur unabhängige Gutachter können feststellen, ob die deutschen Fallpauschalen bei Klinikaufenthalten diesem Anspruch gerecht werden können.

Bildnachweis: © Bergringfoto – Fotolia.com

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