New models of outpatient oncologic care in Germany

Einleitung: Because of medical progress, great parts of oncologic care can take place in outpatient instead of inpatient settings. While in Germany outpatient medical care is traditionally performed by private physician practices also in case of medical specialists, from 2007 on, the legal possibilities of hospitals to participate in the market sector of outpatient oncologic care have improved. But competition does not take place under even conditions: especially regulations concerning quality conditions for admission and reimbursement differ between the competitors in the two sectors. This may lead to underoptimal results concerning quality, efficiency and effectiveness of care. Methoden: This study analyzes the present market situation concerning the actual numbers of different supply units and their shares in outpatient oncologic care, and the change processes initiated by the new legislation. It focuses on the differences in regulations concerning market admission and reimbursement in inpatient oncologic care for private physician practices and for different types of hospitals in Germany. Ergebnisse: Building up on the results, three basic models for a new common set of regulations were developed: · A competitive market model with free market admission without external supply planning for all medical supply units fulfilling certain quality conditions · A central or regional supply planning model using a regulated market admission process for all supply units consented by the head organizations of the German medical system · A central or regional supply planning model nevertheless leaving the authority to buy necessary amounts of oncologic care to the health funds contracting with selected provider units. Diskussion/Schlussfolgerungen: All three models appear suitable to optimize the oncologic care in the outpatient setting and to unitize the market condition of all stakeholders. To reorganize the oncologic care in the outpatient setting sustainably, German legislation needs to define a set of legal regulations for all stakeholders.