Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2026
[Bundled payment: A promising approach in reimbursement? Results from the sekTOR-HF project for left-sided heart failure in Germany].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Arnold Matthias, Gscheidle Sonja, Klähn Ann-Kathrin, Rottenkolber Dominik, Bovy Leonore, Ludwig Marion, Conrad Hans-Joachim, Zehe Denise, Müller Lisa, Griewing Bernd, Barth Sebastian, Auner Harald, Amelung Volker
Аннотация
INTRODUCTION: Reimbursement systems can create significant incentives for service delivery. From a theoretical perspective, the need for reform in reimbursement systems at the interface between outpatient and inpatient care is well established, but practical proposals are lacking. As part of the sekTOR-HF project, a concept for a bundled payment system was developed, and its feasibility in Germany was demonstrated.
METHODS: The framework for a bundled payment system was developed through a participatory design process. A retrospective analysis of statutory health insurance (GKV) claims data (2018-2019) was used to calculate bundle prices for patients with left-sided heart failure. Generalized linear models with a gamma distribution and link function were applied to estimate prices and identify cost drivers.
RESULTS: Four bundled payment scenarios based on NYHA classes were identified. Among 129,262 patients with left-sided heart failure analyzed, the annual reimbursement prices per patient for a bundled payment ranged from €1,928 (NYHA I) to €5,567 (NYHA IV). Several cost-increasing comorbidities ("bundle breakers"), such as renal failure, multiple myeloma, and cardiac arrest, were identified.
CONCLUSION: We developed an initial proof of concept for implementing bundled payments in the German healthcare system. Our findings indicate that viable design options can be identified and that price estimation based on existing routine data is feasible.
METHODS: The framework for a bundled payment system was developed through a participatory design process. A retrospective analysis of statutory health insurance (GKV) claims data (2018-2019) was used to calculate bundle prices for patients with left-sided heart failure. Generalized linear models with a gamma distribution and link function were applied to estimate prices and identify cost drivers.
RESULTS: Four bundled payment scenarios based on NYHA classes were identified. Among 129,262 patients with left-sided heart failure analyzed, the annual reimbursement prices per patient for a bundled payment ranged from €1,928 (NYHA I) to €5,567 (NYHA IV). Several cost-increasing comorbidities ("bundle breakers"), such as renal failure, multiple myeloma, and cardiac arrest, were identified.
CONCLUSION: We developed an initial proof of concept for implementing bundled payments in the German healthcare system. Our findings indicate that viable design options can be identified and that price estimation based on existing routine data is feasible.