• H Mang, U Kunzmann, and M Bauer.
• Anästhesiologische Klinik, Universitätsklinikum Erlangen, Krankenhausstrasse 12, 91054 Erlangen. Harald.Mang@uk-erlangen.de
• Anaesthesist. 2007 Sep 1; 56 (9): 867-76.

AbstractAfter 30 years of belt-tightening in the health care system and the mandatory implementation of the German diagnosis-related groups (DRG) system in 2004, the cost pressure on German hospitals has increased again. Cases break even only if prime costs fall below DRG revenues. On the one hand it is required from hospitals that prime costs are evaluated in terms of effectiveness, but on the other hand they have to allow for generation of adequate revenues and performance-oriented distribution of profits. This article first presents the political background of the German DRG system and then systematically assesses the different types of reimbursement. Aspects in the field of anaesthesia which are relevant to the generation of adequate revenues are: documentation of intraoperatively occurring diagnoses, documentation of intraoperative procedures, the grouper function "complicating procedure", the demographic attribute "hours on mechanical ventilation" and the issue of supplemental revenues. Following comments on the generation of adequate revenues, the alternative means of internal budgeting, the German DRG case-costing and the percentage of sales method, are discussed. The present contribution is intended to assist readers in the prevailing discussion about economic awareness of the health care market.

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