Unnecessary operations?

"The high numbers for hospital treatment in Germany cannot be explained solely by demographic factors such as an aging population or the availability of sophisticated medical technology," said Health Minister Daniel Bahr on Thursday in Berlin, while opening a conference on managing hospital volumes to coincide with World Health Day.

A report carried out by the Organization for Economic Cooperation and Development (OECD) was the basis for Thursday's discussions.

It compared German figures to that of other highly industrialized countries over a five year period from 2005 to 2010 and found numbers that could not be explained by a higher rate in disease.

On average across the 34 OECD nations - ranging form Japan and Australia to the United States and western European countries - 155 in 1000 people are treated in hospital per year.

In Germany the figure is 240 in 1000.

The figures for hip replacements and coronary bypasses were twice and three times the rate of the OECD average, respectively. However, the number of Germans suffering from orthopedic or cardiovascular diseases or orthopedic problems was not significantly higher than elsewhere.

German hospitals are more focused on inpatient care than those elsewhere, the report showed.

Many OECD countries are currently grappling with the challenge of increases in hospital volumes, so policymakers are discussing what represents a "medically appropriate" amount of care.

"While the German health care system may have the financial capacity [and appetite] to continue to underwrite a very available hospital sector, the continual growth of hospital volumes from already high levels risks entrenching incentives for the over-provision and over-supply of hospital services," said the OECD report.

It pointed to an "open-ended approach" to the financing of hospital services and weak controls over the hospital budget than in many other OECD countries, where hospitals have to stick to a fixed annual budget and rationalize their capacity, the report stated.

Germany has a system to classify the "products" hospitals provide, but unlike other OECD countries, Germany uses this as a pricing tool for reimbursement by health insurers rather than an expenditure management tool.

The German hospital federation DKG is keen to avoid any cuts and warned that more than half of all German hospitals could soon be in the red, if current funding levels were reduced.

"Modern medicine as practiced in Germany's hospital benefits especially the growing number of senior patients," DKG President Alfred Dänzer pointed out.

Critics, however argue that surgery is mainly a lucrative business for hospitals seeking to ensure funding and may therefore be given preference over more conservative long term healing methods. With operations costing an average of 12,000 euros ($16,000), German hospitals have a clear financial incentive to conduct as many as possible.

"Hospitals cannot prove that all the operations they carry out are absolutely necessary," said Uwe Deh of Germany's largest health insurer AOK.

The OECD experts suggested that German hospitals should be held accountable by making sure that their finding is pegged to their success rates.

"This would go a long way in ensuring that people really benefit from a medical sector that is one of the best in the world," the OECD concluded its recommendations.

rg/kms (dpa, EPD)