[Extent of rationing and overprovision in stationary care: results of a nationwide survey of German hospitals].

BACKGROUND: Faced with economic pressure and with the insufficient funding of investments many hospitals are in deficit. However, there is little evidence whether these circumstances translate into rationing of services and which factors might be relevant in this context. Concerning the development of the number of patients it is also unclear, whether economic incentives lead to an overprovision of medical services.
METHOD: Based on earlier studies and semi-structured interviews with hospital executives professional group specific questionnaires were developed and sent to almost 5.000 chief physicians, hospital managers and directors of nursing. The response rate was 43 %.
RESULTS: All respondents perceived considerable economic restrictions. In consequence, 46 % of chief physicians have rationed useful services or replaced them by cheaper less effective alternatives. Although rationing is a concern in all medical disciplines the intensity is modest. Moreover, the chief physicians perceived a tendency to overprovision - especially in orthopedy and cardiology.
CONCLUSION: Due to financial restrictions of health funds and federal states the economic pressure will stay high. This implies political actions to prevent negative consequences for patient care. © Georg Thieme Verlag KG Stuttgart · New York.