Fallpauschalen

Fallpauschalen, in the German hospital financing context, are fixed lump-sum payments per inpatient case. They are part of the diagnosis-related group (DRG) based system used to reimburse hospitals for hospital stays. The term refers to the flat-rate amount hospitals receive for treating a patient during one admission, rather than reimbursements for each individual service provided.

In Germany, the system is organized through the G-DRG (German DRG) catalogue, which classifies cases according to diagnoses, procedures, age, sex, and the presence of complications or comorbidities. Each DRG has a relative weight that reflects the expected resource use for typical cases within that group. The remuneration for a hospital stay is calculated by multiplying the DRG weight by a base rate (basisfallwert), with adjustments for region, year, and other factors. Additional payments, known as Zusatzentgelte, may apply for certain high-cost services or outlier cases, while some unusually short or long stays may receive special outlier payments.

The system is administered by the Institute for the Hospital Remuneration System (InEK), which publishes the DRG catalog and base rates annually. Hospitals code diagnoses and procedures to determine the appropriate DRG, and coding quality directly influences reimbursement. The aim of fallpauschalen is to standardize, simplify, and stabilize hospital financing, increase transparency, and promote efficiency and predictable budgeting in inpatient care.

Critics point to potential incentives to shorten lengths of stay, risk selection, and upcoding concerns, as DRG-based payments reward efficient resource use but may inadequately reflect patient complexity in some cases. Ongoing reforms address these issues by refining DRG groupings, adjustments, and outlier mechanisms. The approach is primarily used in Germany, though DRG-based financing is common in many countries with national adaptations.