Table 4 Potential gateways to institutional corruption
Breakdown/motivation structure according to federal/state laws | potentially promotes | puts at risk |
|---|---|---|
• Existence of a physician fee per se | prioritization of supplementary- insured patients, increasing/by-passing public waiting lists | equal treatment for equal needs in terms of volume, range, timing and access |
• Restriction of hospital and physician fees to inpatient (day) care | inpatient care of outpatient (ambulatory) care | service provision at the ‘best point of service’ and relief of the inpatient sector |
• Limiting the special-class bed capacity to 25% of the overall bed capacity | high capacity utilization | reasonable reduction in the overall bed capacity and capacity-reducing innovations |
• Tariffication of physician fees | overprovision of medical services, prolongation of length of stay | equal and efficient service provision |
• Possibility of dual practice | redirection of profitable patients to private practice/private hospital | service provision at the ‘best point of service,’ coordinated service provision, prevention and decrease of parallel structures and relief of the inpatient sector |
overprovision of medical services through self-referral | ||
focus on private practice at the expense of public health care provision | ||
misuse of public resources for privately offered medical services | ||
absenteeism | ||
outflow of public hospitals’ resources to private hospitals |