Vorlesung HCM_Prof. Merk
DHBW Stuttgart Health Care Management
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Introduction to the course by Prof. Dr. Wolfgang Merk
Gliederung
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1. Einführung
1.1 Fallbeispiel Krankenhaus1.2 Fallbeispiel Arztpraxis
2. Gesundheit als besonderes Gut
2.1 Definition Gesundheit2.2 Gesundheit als Gut2.3 Gesundheit als Dienstleistung
Gliederung
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3. Management allgemein
3.1 Grundbegriffe3.2 Managementlehre
4. Health Care Management
4.1 Einführung4.2 Der Markt des Gesundheitswesen4.3 Finanzierung4.4 Entwicklung Med-Tec4.5 Blick ins Ausland
Gliederung
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5. Trends im Gesundheitswesen
5.1 Demografische Entwicklung5.2 Epidemiologie5.3 medizinisch-technischer Fortschritt5.4 Digitalisierung und KI
Einführung
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Overview of the introduction
Einführung
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1.1 Fallbeispiel Krankenhaus
Name: Markus Weber
Age: 48 years
Marital Status: Married, 3 children
Position: Managing Director of Luisenhospital for 12 months (regular care hospital in Southern Germany)
Professional career:
Graduate of DHBW Stuttgart
Trainee program Helios Clinics
Deputy Head of Personnel at Robert-Bosch-Krankenhaus
Assistant to Management Sana Clinics
Managing Director Luisenhospital
Task: To lead the hospital back into profitability within three years.
Einführung
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1.1 Fallbeispiel Krankenhaus
Current Challenges
Filling the Chief Physician position in Orthopedics & Trauma Surgery.
Nearby hospital (30 km away) expanding gynecological department with aggressive marketing.
Another hospital (50 km away) declared bankruptcy.
The Multi-Functional Center (MVZ) attached to Luisenhospital is underutilized due to low recognition.
Plans for expansion of the MVZ are on hold due to lack of funds.
Einführung
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Krankenhausinsolvenz
Increasing wave of insolvencies threatening German hospitals.
Over 26 entities have declared insolvency for more than 34 hospitals since November 2022.
Over 50% of clinics report financial losses.
Einführung
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Current Financial Status
70% of hospitals report a deficit for 2023, a 19% increase year-on-year.
Profit/loss analysis from years 2019-2023.
Einführung
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Krankenhausreform
Federal government's plan for "de-economization" of hospital funding, aimed at financial independence from service provision.
Einführung
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Goals of Reform
To overcome the hamster wheel effect through advance budgets.
Ensure international treatment quality and reduce bureaucracy.
The exact funding strategies remain unclear.
Einführung
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Ambulantes Operieren
New measures for outpatient procedures effective from January 2024.
Agreement on making outpatient surgery more attractive.
Einführung
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Hybrid-DRG
Introduction of a sector-equal payment system in 2024.
Start catalog includes various medical procedures that can be billed through hybrid DRGs.
Einführung
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Exclusions for complex inpatient procedures and high-cost diagnoses.
Einführung
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Fachkräftemangel
Projected shortage of nearly 1.8 million open positions in healthcare by 2035.
Increasing vacancies already seen in 2022.
Einführung
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Own representation based on Pwc data regarding workforce shortages.
Einführung
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Krankenhausfinanzierung
Breakdown of user fees (public vs. private) and operational cost structure for hospitals.
Einführung
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Investitionsstau
Annual investment requirement for hospitals exceeds 6 billion euros, only 50% funded by the states.
Einführung
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Comparison of Funding
Historical development of funding from states relative to healthcare expenditures since the 70s.
Einführung
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Cost Structure Example of a Hospital
Total budget of approx. 100 million €
Summary of costs associated with personnel, supplies, operations, capital depreciation, and administration.
Einführung
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Cost Structure Characteristics
High personnel costs (~60%)
Significant supply costs (approx. 15%)
Considerable operating costs (approx. 10%)
Einführung
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1.2 Fallbeispiel Arztpraxis
Name: Dr. med Carmen Wind
Age: 39 years
Currently running a solo practice with a 180.000 € profit in the first year.
Einführung
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Challenges in Dr. Wind's Practice
Demand for telemedicine services from patients.
Need for new hire due to staff leave.
Administrative burden consuming 6 hours per week, limiting patient care.
Telemedicine
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Definition and examples of effective telemedicine applications in healthcare.
Telemedicine
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Established Offerings
Examples include video consultations and digital health apps (DiGA).
Telemedicine
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Capabilities in Contractual Medical Care
Tele-consultations and tele-monitoring for monitoring conditions.
Ärzte an der Belastungsgrenze
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Over 50% of physicians considered leaving the profession due to various pressures.
Bürokratisierung
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Bureaucracy Index
Reflection of increasing bureaucratic burdens on medical professionals.
Bürokratisierung
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Suggested measures to reduce bureaucracy for doctors.
Gliederung
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Summary of bureaucratic load on contract doctors.
Gliederung
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Recommendations
Suggestions to streamline processes and reduce administrative duties.
Einführung
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Overview of doctor shortage across various regions.
Ärztemangel
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Factors Influencing Shortage
Decreasing number of physicians willing to work as contract doctors, especially in primary care.
Kostenstruktur
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Example of Costs in a Contracted Physician Practice
Detailed breakdown of costs associated with a million-Euro turnover practice.
Kostenstruktur
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Characteristics of Cost Structure in Physician Practices
Relatively high personnel costs (25% of turnover).
Selbstcheck
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Review Questions
Key questions reflecting knowledge acquired from the lecture.
Gesundheit als besonderes Gut
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Introduction to the section on health as a unique asset.
Definition Gesundheit
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Translation of the WHO Definition
Definition emphasizing the holistic nature of health.
Gesundheit als besonderes Gut
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Health is a lifelong priority requiring adequate political measures to ensure access to care.
Gesundheit als besonderes Gut
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Functional Health
Expansion of the WHO definition to include various components of health.
Gesundheit als besonderes Gut
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Interdependence with Healthcare System
Health is influenced by multiple social and environmental factors.
Gesundheit als besonderes Gut
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Economic View of Health
Health deemed as the highest good of humanity and the balance between health and other goods.
Gesundheit als besonderes Gut
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Visual representation highlighting the significance of health and family.
Gesundheit als ökonomisches Gut
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Allocation and Scarcity
Economic principles applied to healthcare demands for optimal resource distribution.
Gesundheit als ökonomisches Gut
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Importance of governmental regulation in managing healthcare resources effectively.
Vom "Krankheitswesen" zum "Gesundheitswesen"
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Shift in focus towards preventative health measures.
Gesundheitsleistungen
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Characterization of Health Services
Properties of healthcare services distinguishing them from other economic goods.
Diskurs – Ethik und Gesundheit
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Ethical Considerations
Examples raising questions about medical ethics and healthcare funding.
Diskurs – Ethik und Gesundheit
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Case Study Example
Discussion of ethical dilemmas tied to healthcare provision and government regulations.
Diskurs – Ethik und Gesundheit
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Fundamental Ethical Questions
Ethical queries regarding resource allocation in healthcare.
Klinische Ethik
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Overview of relevant ethical frameworks in healthcare.
Leistungserstellungsprozess im Krankenhaus
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Identification of Input/Output Processes
Explanation of the primary and secondary processes within healthcare service provision.
Faktormodell der Gesundheitsproduktion
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Change in Health Status
Description of the treatment process tied to inputs and outputs in healthcare.
Patientenzufriedenheit als Motivation
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Factors Impacting Patient Satisfaction
Identification of parameters affecting patients’ satisfaction levels in healthcare settings.
Informationsasymmetrie im Gesundheitswesen
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Challenges in Doctor-Patient Relationships
Discussion on the complexities surrounding healthcare information.
Erfahrungs- und Vertrauensgüter
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Description of the patients' trust and experience-based evaluation in healthcare services.
Selbstcheck
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Review Questions
Questions addressing core concepts from the health as a special good segment.
Management
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Introduction to management principles in healthcare.
Wirtschaften
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Economic Behavior in Resource Allocation
Overview of maximizing resource efficiency.
Ökonomisches Prinzip
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Explanation of the three economic principles applicable to management.
Effektivität vs. Effizienz
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Understanding the Key Concepts
Differentiation between effectiveness and efficiency in goal achievement.
Rationalprinzip
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Patient Behavior in Economic Models
Critique of the rational actor model in healthcare decision-making.
Betrieb
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Definition of a Business
Explanation of organized economic units producing goods and services.
Betriebliche Leistungserstellung
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Processes involved in the production of healthcare services.
Entstehung der Managementlehre
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Historical Development
Overview of management theory origins and adaptation to complex environments.
Was ist Management?
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Definition and scope of management studies in healthcare.
Bestandteile eines Systems
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Component definitions related to system interactions.
Management Funktion
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Description of Management Activities
Overview of core management responsibilities in healthcare.
Managementkreislauf
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The Planning and Control Process
Details on how management processes cycle through planning and control phases.
Strategieentwicklung
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Future-Oriented Management
Strategic planning for the future of healthcare businesses.
Aufgaben von Managern
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Management Styles and Challenges
Outline of management roles according to Mintzberg's model.
Case Study
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Practical Application for Managers
Managing an open system amidst market changes.
Health Care Management
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Introduction to health care management concepts.
Das dt. Gesundheitswesen
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Overview of Healthcare System Players and Regulations
Complexity of German health care system settings.
Lebenserwartung
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Trends in Life Expectancy
Data on life expectancy in Germany from 1950 to 2070.
Bevölkerung
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Demographics of Germany
Population distribution and aging trends from 2030 to 2070.
Krankenversicherungsschutz
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Health Insurance Coverage Overview
Statistics on health insurance populations in Germany.
GKV - Pflichtmitglieder
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Membership Statistics
Changes in compulsory and voluntary insurance membership.
Krankenversicherung
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Trends in Health Insurance Market
Consolidation of health insurance providers in Germany.
Gesundheitsausgaben
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Breakdown of Health Expenditures
Total health expenditures in 2022 sorted by funding sources.
Krankenhäuser nach Trägerschaft
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Ownership Trends of Hospitals
Analysis of the number of hospitals by ownership type from 2002 to 2022.
Krankenhausindikatoren
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Hospital Performance Metrics
Comparative index of hospitals across multiple factors from data between 1991 and 2021.
Leistungsausgaben
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GKV Expenditure by Service Area
Overview of the healthcare spending distribution in Germany for 2023.
Gesundheitsausgaben
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OECD Health Expenditure Data
Comparison of health expenditures across select OECD countries.
Markt des Gesundheitswesens
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Structure of the Healthcare Market
Overview of service offerings in health economics.
Gesundheitsökonomie
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Definition and Scope
Exploration of production, distribution, and consumption of healthcare goods.
Politische und unternehmerische Verantwortung
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Roles in Health Economics
Responsibilities of individuals in healthcare management and policy.
Angebotsinduzierte Nachfrage
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Demand and Supply Interactions
Explanation of how supply influences patient demand in healthcare.
Moral Hazard
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Risk-taking Behaviors in Healthcare
Discussion on moral hazard implications in patient behaviors and insurance.
Finanzierung
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GKV Health Fund
Overview of the health fund structure and financial management.
Morbiditätsorientierter Risikostrukturausgleich
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Risk Adjustment Mechanism
Explanation of the functioning of the morbid-state structure since 2023.
Beispiel Fresenius Medical Care
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Company Evolution
Overview of Fresenius Medical Care’s development from an infusion provider to a global MedTech leader.
Case Study
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Developing Health Companies in New Markets
Analysis of market entry strategies for health services in countries like Bangladesh.
Trends im Gesundheitswesen
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Overview of current and emerging trends affecting healthcare.
Demografische Entwicklung
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Population Structure Analysis
Comparison of population demographics between 1990 and 2022.
Bevölkerungsentwicklung
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Population Forecasts
Projected changes in population numbers from 1960 to 2060.
Todesursachen
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Historical Trends in Mortality
Analysis of death rates from common diseases from 1892 to 2010.
Todesfälle
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Recent Mortality Data
Statistics on number of deaths from various causes in Germany from 2021 to 2023.
Epidemiologie
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Role of Epidemiology in Public Health
Importance of epidemiology in addressing health crises like COVID-19.
Bewegungsmangel
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Health Risks of Sedentary Lifestyle
Discussion on the implications of decreased physical activity due to modern lifestyles.
Technologischer Fortschritt
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Innovations in Healthcare
Overview of advancements in health technologies including AI and virtual care.
Digitalisierung
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Opportunities in Digital Health
Potential benefits and legislative changes promoting digital health transformation.
ePa Implementation
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Evaluation of Electronic Patient Records
Overview of the electronic patient record’s implementation and its features.
Wiederholungsfragen
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Review Questions
A set of questions summarizing key concepts from the management and health sections.
Wiederholungsfragen
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Final Questions
An additional set of review questions for exam preparation.