Capacity Utilisation and Quality of Care in German Hospitals

The main objective of this study is to empirically assess the relationship between capacityutilisation and quality of care in German hospitals. Many international studies show a relationshipbetween staff to patient ratios or bed utilisation and the quality of care provided inhospitals but evidence for Germany is lacking so far. In the last decade there was a decreasein hospital beds and an increase in hospital cases with a fair increment in staffing levels forphysicians and a moderate decrease for nurses. In times of a high level demand of hospitalservices, it is sensible to assume that maintaining a sufficient level of quality of care maybe difficult. Additionally, the recent change in hospital reimbursement from a retrospectivesystem to the prospective DRG-System sets more incentives to increase patient cases andhence to wide capacity utilisation as well, possibly at the expense of quality of care. Theconsequences of this change are assessed using German data. For the empirical analysisaround 135 000 patient cases from 8 German hospitals from the year 2004 are used. Thedata are a full sample of all patients admitted to these hospitals in the respective year. Theoutcome variable is daily mortality ratio. The results of multivariate regression models includingpanel models suggest a deteriorating effect of increasing bed utilisation on quality ofcare. Meaningful conclusions about staff to patient ratio are not possible due to insufficientdata.