OBJECTIVES:

Due to disincentives inherent in systems of diagnosis-related groups (DRGs), additional payments for newly approved technologies complement these prospective payment systems. In Germany, so called innovation payments are negotiated between individual hospitals and health insurances. Thus, hospitals may not have the same chance of being reimbursed for new, more expensive technologies. This study aims at investigating this temporary reimbursement mechanism. We examine factors that might be associated with agreeing innovation payments.

METHODS:

Based on a data set of the Scientific Institute of the AOK (including agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances) and data of the German Federal Statistical Office on state level, multilevel logistic regression was estimated to examine factors at hospital and state level. All German acute hospitals and innovation payments on all diagnoses are thus included in the study. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n=1,358).

RESULTS:

In total, 32.9 per cent of the hospitals successfully negotiated innovation payments in 2013 (31.3 per cent of non-university hospitals, 91.9 per cent of university hospitals). The share of hospitals that successfully negotiated innovation payments varied considerably among the states. The chance of negotiating innovation payments increased for large and private for-profit hospitals and hospitals with university status. Additionally, hospitals located in areas with a low degree of competition – such as rural areas – had a lower chance of negotiating innovation payments.

CONCLUSIONS:

The study indicates that policy making generally compensates disincentives of the DRG system by additional innovation payments. Patient safety is implicitly fostered by favouring university hospitals and large hospitals to use new technologies. However, the innovation payments may impede patient access in rural areas since hospitals in regions with low competition have a smaller chance to receive innovation payments.