Effekte der Hybrid-DRG-Einführung – eine Analyse auf Basis von AOK-Daten

On 1 January 2024, the introduction of hybrid DRGs in accordance with Section 115f of the German Social Code, Book V (SGB V) established a cross-sector, uniform remuneration system for certain medical services. The aim is to shift services that can be provided safely, with appropriate quality and effectively in an outpatient setting, but which – unlike in other countries – have traditionally been provided on an inpatient basis in Germany, to the outpatient sector. In addition, the aim is to promote the more efficient use of medical professionals and to strengthen the economic efficiency of statutory health insurance (GKV) while maintaining the same quality of care [1, 2]. The hybrid DRG remuneration system applies to both contract doctors and inpatient care and covers the following five service areas: certain hernia operations, removal of ureter stones, oophorectomies (removal of the ovaries), arthrodesis of toe joints (joint stiffening) and removal of coccyx fistulas (pilonidal sinus). For 2024, the Institute for the Hospital Remuneration System (InEK) has assigned a total of twelve hybrid DRGs to these five service areas. Until 31 December 2023, these procedures could be billed either on an outpatient basis according to the Uniform Assessment Standard (EBM) or on an inpatient basis using DRGs.