Hospital statistics - basic data of the hospitals and the prevention or rehabilitation facilities - Methods [general]
Data owner: Federal Statistical Office
Hospital statistics - basic data
All data refer - unless otherwise noted - to the reference day December, 31, of the reporting year.
Type, extent and purpose of the survey
It is an annual complete count of hospitals as well as prevention or rehabilitation facilities, their organizational units, personnel and material equipment as well as the services they provide. Additionally data about training facilities in hospitals are recorded. The facilities are obliged to provide information. The basic data of hospitals and prevention or rehabilitation facilities provides results about supply capacity and structure in the field of inpatient health care. It forms the counterpart of the diagnostic data of hospital patients, which shows the demand capacity and structure (series 6.2). Its results build the statistical basis for many health policy decisions of the Federal Republic and the Federal Länder and act as planning basis for the institutions which are involved in the hospital financing. It also provides data for science and research and contributes to the information for the population.
Facilities of inpatient care
Facilities of inpatient care include
- hospitals and
- prevention or rehabilitation facilities.
Scope of the statistics
According to the extensive hospital term of § 2 No. 1 KHG (hospital financing act) hospitals are facilities, where by medical and nursing services diseases, suffering or physical injuries are to be diagnosed, cured or palliated, or obstetrical services are offered, and in which the patients can be accommodated and looked after.
Prevention or rehabilitation facilities
Prevention or rehabilitation facilities are facilities, where by medical or nursing assistance the state of health of the patients is improved according to a medical treatment plan mainly by application of treatment including physiotherapy, kinesitherapy, speech therapy or work and occupational therapy and by other suitable means, including also mental and psychiological influences. They are also set up to help the patients in the development of their own defence and healing forces and they are facilities in which the patients can be accommodated and looked after.
Types of hospitalsIn the hospital statistics hospitals are subdivided as follows:
are hospitals, which are equipped with beds in fully-inpatient specialist departments, where the beds are not exclusively reserved for psychiatric, psychotherapeutic or psychiatric, psychotherapeutic and neurological patients.
are hospitals with exclusively psychiatric, psychotherapeutic or psychiatric, psychotherapeutic and neurological beds as well as pure day or night clinics. In case of formation of time series it is important to note that in the years 2002 to 2004 also hospitals with only neurological beds were counted as "other hospitals". Until and including 2001 and since 2005 only the combination of psychiatric, psychotherapeutic and neurological beds leads to a count within "other hospitals".
German army hospitals
are listed in the hospitals statistics as "informative" item, as far as services for non-military patients are rendered. In the data for "hospitals total" these figures are not included.
Classification criteria for inpatient facilitiesHospitals and prevention or rehabilitation facilities are classified by the following criteria:
Type of accreditationThe classification of hospitals by accreditation is based on § 108 of the Code of Social Law V (Fünftes Buch Sozialgesetzbuch - SGB).
- University clinics, i.e. hospitals which are sponsored according to regulations of federal state ("Länder") law for university construction,
- state planned hospitals, i.e. hospitals, which have been taken up in the hospital plan of a Federal State (German Land).
- hospitals with a supply contract according to § 108 No. 3 SGB V, which are licensed for hospital treatment of insured persons because of a supply contract with the regional associations of the health insurance and the associations of substitute health insurance companies.
- other hospitals (hospitals without a supply contract), which do not belong to any of the above categories.
Prevention or rehabilitation facilities are divided according to their accreditation corresponding to § 111 SGB V into those
- with a supply contract, i.e. with an accreditation to supply insured persons with inpatient medical services for prevention or rehabilitation,
- without a supply contract with the regional associations of the health insurance and the associations of substitute health insurance companies.
Type of supporting organizations and of the legal formAccording to the type of supporting organizations and the legal form the facilities can be differentiated as follows:
- Public hospitals and prevention or rehabilitation facilities can be conducted under public or private-law. Hospitals or prevention or rehabilitation facilities, which are operated under public law are either legally independent (e.g. administration union ("Zweckverband"), institution, foundation) or legally dependent (e.g. "Regiebetrieb" or "Eigenbetrieb"). Hospitals and prevention or rehabilitation facilities operated under private law (e.g. as a limited company, "GmbH") are considered to be publicly run, if regional corporations (federal government, federal states, district, county) or unions of such public bodies (e.g. working groups or administration unions) or social insurance organizations (e.g. pension fund organizations) hold directly or indirectly more than 50 percent of the nominal capital or of the voting rights.
- Non profit hospitals and prevention or rehabilitation facilities in the public interest ("freigemeinnützig") are maintained by institutions of religious and free social welfare, parishes, foundations or associations.
- Private hospitals and prevention or rehabilitation facilities require a concession as a business enterprise according to § 30 Trade Regulation Act ("Gewerbeordnung").
In case of hospitals or prevention or rehabilitation facilities with different supporting organizations, the supporting organization is specified, which is mainly involved or which mainly bears the costs.
According to the classification criterion of the medical staff institutional hospitals and private bed allocation hospitals can be distinguished. In the hospital statistics only the pure private bed allocation hospitals (Belegkrankenhaus) are reported within this category. These are hospitals, which have exclusively privately allocated beds, i.e. beds which are used by practitioners, who have their own practice, for inpatient treatments of their patients.
Number of specialist departments
A further classification of hospitals and prevention or rehabilitation facilities is based on the number of specialist departments.
With this criterion statements about specialisation and differentiation within the range of services of hospitals and prevention
or rehabilitation facilities are possible.
If a hospital or a prevention or rehabilitation facility indicates to have "other specialist departments" - i.e. specialist departments, which are not listed in the given classification of specialist departments - this fact is listed as one specialist department in the classification by the number of specialist departments. So, perhaps the situation is not shown correctly, in particular, when the category of "other specialist departments" for the relevant hospital or the prevention and rehabilitation facility includes more than one specialist department.
For the number of specialist departments the main areas and subordinate fields are counted. That means, in a hospital, which has a thorax surgery department and this is a subordinate field of the surgery department, two specialist departments are counted. Because of this mode of counting there are deviations from the "number of specialist departments total", because only the main areas are included in this position.
Number of beds
The classification by the number of installed beds gives information about the size of a facility. Therefore in the hospital statistics groups in terms of number of beds are formed, which show depending on survey variables and reporting target a different width of classes. The number of beds is calculated as an annual average of the beds at the end of each month. Not included are beds for partly inpatient or outpatient patients.
SubsidizationThis classification is based on the percentage of subsidized beds of all installed beds in the facility. The following classes are distinguished:
- Subsidized hospitals have only installed beds, which are subsidized by the Hospital Financing Act (KHG - Krankenhausfinanzierungsgesetz) and/or provisions of federal state law for the university construction
- Partly subsidized hospitals: Hospitals, where the number of subsidized beds is greater than zero and smaller than the number of all installed beds.
- Not subsidized hospitals have no subsidized beds.
Medico-technical large-scale equipment
Reported are special equipments and medico-technical large-scale equipment, which are in possession of the facility and which are used for the care of patients in the facility. Not counted is equipment, which is only used for demonstration and teaching purposes or which is only used by practitioners with own practices. If equipment is used by several facilities, it is only reported by the facility, where it is installed.
Collected is the number of dialysis places in facilities. Places which are maintained by third parties, for example curatorships ("Kuratorien") or medical practices are not counted.
Day and night clinic places
Day and night clinic places serve for partly inpatient medical care of patients during the day or the night.
Specialist departments by speciality/field
Specialist departments are organisationally separate departments with special treatment equipment, run under the permanent supervision
of practitioners. The classification of the specialist department is based on the field or subordinate field qualifications of the
medical practitioners. Exceptions from this are the specialist departments geriatrics and addiction. In a hospital structured by specialist
departments the corresponding organizational units are assigned to one of the listed specialist departments.
For reasons of a uniform way of counting there is no separate statement of a specialist department "intensive care medicine" in the statistics. If there is an organisationally independent specialist department "intensive care medicine" in the hospitals, its beds are listed according to use with the listed specialist departments. The same applies to the patients who are treated there and the occupancy and billing days. Transfers to and from the specialist department "intensive care medicine" are not counted in the statistics. Cases and days are then further recorded with the delivering specialist department. As far as an admission of a patient takes place directly from outside into the intensive care medicine, the patient data are assigned to one of the listed specialist departments.
Specialist departments without inpatient beds
Specialist departments without inpatient beds are delimitable departments with specific therapeutic or diagnostic facilities, which have no own installed beds.
Geriatrics department and organisationally delimitable specialist facilities
This criterion was reported for the first time in 2002. The term "specialist facility" refers to an
organizational unit below the department level, e.g. a ward or even just a number of beds. The purpose of
specialist departments is the treatment of patients according to § 13 section 2 BPflV, for example AIDS patients,
patients with mucoviscidosis and patients with transplantations. The facilities to treat paraplegic patients and patients
with massive burns are reported within the specialist facilities. Special daily rates for patient care apply for geriatrics
departments and the specialist facilities.
In 2007 the "geriatrics department" was again integrated into the "normal" classification of specialist departments. To ensure uniform reporting, the sub-item of clinical geriatrics in internal medicine is no longer applicable and the geriatrics will no longer be reported within the "specialist facilities".
Organisationally delimitable facilities to treat paraplegic patients, patient with massive injuries to skull and brain, patients with massive burns, patients with AIDS, patients with mucoviscidosis, oncology patients, patients with transplantations or facilities for neonatological intensive care have been reported in the hospital statistics since 2002.
Beds installed are all the beds available in the hospitals, which are appointed for fully-inpatient treatments. The number of beds installed is calculated as an annual average of the available number of beds at the end of each month. The counting of beds takes place independently of their support. Beds for partly inpatient or outpatient accommodation, beds in examination and functional rooms as well as beds for healthy newborn children are not included. A subdivision takes place e.g. by their support:
- Beds, which are subsidized by provisions of federal state law for the university construction,
- Beds, on which the authorization of the subsidy funds according to KHG (Article 8 Section 1) is based.
- Contract beds according to § 108 No. 3 SGB V, for which there are contracts with the statutory health insurances about the grant of hospital treatments,
- Other beds, especially in hospitals of private ownership, which neither are included in the hospital plan nor subsidized and for which no contracts according to § 108 No. 3 SGB have been signed.
In prevention or rehabilitation facilities:
- Contract beds according to § 111 SGB V: all installed beds, for which there are contracts with the statutory health insurances about the grant of medical services for prevention or rehabilitation including follow-up treatment.
- Other beds: installed beds, for which there are no contracts with the statutory health insurances according to § 111 SGB V. In "other beds" also those beds are reported, for which there are contracts with the supporting organizations of pension insurances or accident insurances.
Privately allocated beds (Belegbetten)
Privately allocated beds are beds which are used by practitioners with their own practice for fully inpatient care of their patients.
Intensive care beds
Intensive care beds are beds, which are installed for intensive medical care. Their number is calculated as an annual average, just like the overall number of beds installed. The intensive care beds also include beds with monitoring equipment for the seriously ill, but not recovery beds. For subsidized hospitals only those intensive care beds are listed, which are admitted according to the hospital plan respectively the subsidy notice. However elsewhere all installed intensive care beds are listed.
Emergency beds are beds with special additional facilities for the temporary treatment in case of acute disease conditions of rehabilitation patients. In the hospital statistics they are therefore only reported in the prevention and rehabilitation facilities. Normally, patients with acute diseases are transferred into a hospital for further treatment.
Degree of utilization
The degree of utilization depicts the average utilization of beds in per cent. The actual bed occupancy is set in relation to the maximum bed occupancy. The maximum bed capacity is the result of the product of installed beds and the number of calendar days in the reporting year. The actual bed occupancy is the sum of calculation days and occupancy days, because every patient occupies one bed per inpatient day in the facility. The degree of utilization respectively the utilization of beds is expressed as a percentage and is calculated by the following formula:
|Occupancy/billing days or days of care|
|Average occupancy rate per bed||=||x 100|
|installed beds x calendar days in the reporting year|
Occupancy/billing days and days of care
Starting from 2002 the expression "days of care" was replaced by the expression "occupancy/billing days". In the field of the prevention or rehabilitation facilities the expression "days of care" further exists.
Billing days are the days, for which daily rates for patient care (basic daily rate for patient care, department daily rate for patient care or partly inpatient daily rates for patients) are invoiced (calculated). According to § 14 section 2 BPflV the department daily rates for patient care and the basic daily rate for patient care as well as the corresponding partly inpatient daily rate for patient care are calculated for the admission day and every further day of the hospital stay (billing day). The discharge or relocation day, if it is not the same as the admission day, is only calculated in case of partly inpatient treatment.
An occupancy day is a day, when an installed bed is fully occupied by an inpatient. An occupancy day within the lump-sum pay
system is the equivalent to a billing days within the federal regulations of hospital daily rates for care
("Bundespflegesatzverordnung"). In the course of the implementation of the
lump-sum pay system based on the Diagnosis Related Groups (DRGs)
the occupancy days are reported according to § 1 section 6 of the
"Verordnung zum Fallpauschalensystem für Krankenhäuser (KFPV)".
Occupancy days are the admission day as well as every further day of the hospital stay without days, when patients are relocated or
discharged. If a patient is admitted and relocated or discharged on the same day, this day is regarded as admission day.
The number of occupancy/billing days is the sum of the full inpatients on each day of the reporting year at 12 p.m. (sum of midnight stock). The admission day - also in hour cases - as well as every further day of the hospital stay is counted as occupany or billing day. Days, when patients are discharged or relocated are not counted. Therefore an hour case causes an occupancy day - in contrast to the reporting years prior to 2002. Days of intensive care treatment/intensive care monitoring are occupancy/billing days for patients, who are treated in intensive care beds.
Days of care
In the field of the prevention or rehabilitation facilities the admission day as well as every further day of the stay is counted as day of care. Days, when patients are discharged or relocated are not counted. Days of emergency monitoring are reported. Days of emergency monitoring are spent in emergency beds, in which rehabilitation patients with temporary acute diseases are treated. Normally, those patients are transferred into a hospital for further treatment.
As patient admission only those patients (cases) are counted, who are admitted into the fully inpatient division of the facility.
Only partly inpatients or outpatients as well as healthy newborns and accompanying persons are disregarded. Within the admissions into
the fully inpatient treatment of the facility, transfers from hospitals and admissions from the partly inpatient treatment are separately reported.
If patients are on leave for one or more days, their return is not counted as a new admission.
Prevention or rehabilitation facilities
As patient admission only those patients (cases) are counted, who are admitted into the fully inpatient division of the facility. Only partly inpatients or outpatients as well as accompanying persons are disregarded. Within the admissions into the fully inpatient treatment of the facility, transfers from hospitals are separately reported. If patients are on leave for one or more days, their return is not counted as a new admission.
As patient discharge those patients (cases) are counted, who either have been discharged from the fully inpatient division of the hospital or who died during the stay in hospital. Patient discharges in the form of transfers into other hospitals, discharges into inpatient prevention or rehabilitation facilities or nursing care homes as well as transfers into partly inpatient treatment of the same hospital are reported separately.
Prevention or rehabilitation facilities
As patient discharge those patients (cases) are counted, who have been discharged from the fully inpatient division of the facility or who died during the stay in the facility. Patient discharges include patients, who where relocated from the facility into a hospital for further care.
Number of cases
Until 2001 the inpatients (cases) were reported without the so-called hour cases within a day. Starting
from 2002 a separate statement is no longer possible.
The number of cases is calculated by means of patient admissions and discharges. In the Hospital statistics there is a differentiation between a facility oriented and a specialist department oriented number of cases. For the latter, the internal transfers are included.
The determination of the number of cases includes deaths. The formula for the facility oriented number of cases is:
|patient admission||patient discharge|
fully inpatient discharge
The formula for the specialist department oriented number of cases includes in contrast internal transfers:
fully inpatient admission + relocations
from other departments
fully inpatient discharge + relocations
to other departments + deaths
Average length of stay
The "average length of stay" indicates the average number of days, a person spent as full-time inpatient.
It results from the occupancy and billing days respectively days of care and the number of cases of the respective specialist department or facility as follows:
|occupancy/billing days respectively days of care|
|Average length of stay||=|
Facility practitioners include all practitioners with fixed employment in the facility. Guests, consultants and practitioners in job-shadowing are not included. We distinguish:
- chief consultants:
This includes all facility practitioners with a chief physician contract as well as practitioners as owner of concessionary private clinics.
- senior physicians
- assistant physicians
Dentists are reported only for information. They are not included in the sum of facility practitioners.
The practitioners are classified, as far as they have a certified further qualification, by their specialization. Practitioners with several specializations are classified by their mainly practised activity. Practitioners with specialization ("Schwerpunkt") (for example vascular surgery) are counted in the statistics according to the field (for example surgery). Practitioners without or in a first further training can not be assigned to a field and are reported separately.
private bed allocation practitioners:
Private bed allocation practitioners are practitioners with their own practice and others not employed in the facility who are entitled to treat their patients as inpatients or outpatients in the facility, using the services, equipment and means placed at their disposal, but without receiving any remuneration from the facility.
physicians who are employed by private bed allocation practitioners:
Physicians who are employed by private bed allocation practitioners are recorded according to the field or subordinate field designation of the employing practitioner.
Full-time staff in the annual average / full-time equivalent with and without direct employment
The number of employees on 31 December does not account for different employment models. This includes e.g. part-time workers and employees, who were only employed in the facility for a part of the year, but not on the effective day (for example short-term auxiliary employees). To take this into account full-time equivalents are built, i.e. there is a conversion to the full working hours according to the collective labour agreement. Overtime and standby services are not included in the calculation. In the Hospital statistics the term "full-time staff" is used. Their number is calculated as an annual average.
For some staff-groups there are special conversion factors. Trainee nurses and trainee children's nurses are considered at
a ratio of 9.5 to 1, trainee auxiliary nurses are considered at a ratio of 6 to 1 in the calculation of full-time staff.
Civil service conscripts ("Zivildienstleistende") are converted at a ratio of 1 to 1.
Starting from 2009 the number of those full-time staff, who are not in a direct employment with the facility, but e.g. in personnel leasing are reported in addition to full-time staff with direct employment. This kind of personnel is only counted if the respective service is done by the facility and if the facility acquires personnel assistance in the form of temporary employment or the like to do this task. Staff of an external company, which for example has taken over the cleaning of the facility, is not counted; in this case the (outsourced) cleaning is no longer considered a service of the facility. Medical staff without direct employment can be freelancers or physicians who are appointed to the facility by an intra group personnel company. In case of non-medical personnel without direct employment both intra group personnel companies and temporary employment play a role.
Strain on staff factor
The strain on staff factor based on the number of occupied beds indicates, how many occupied beds a full-timer has to care for on average per working day. Since 2009 the working hours of a full-timer are taken into account to represent the fact, that an occupied hospital bed requires care for 24 hours per day, but a full-timer is only available on 220 working days per year on average and (only) eight hours every day. The personnel load factor results as quotient from the number of hours, the hospitals beds were occupied in one year (= occupancy hours of hospital beds in a year) and the number of hours, that the full-time staff for the care of hospital beds in a year were available (= annual working hours of full-time staff).
|(occupancy and billing days * 24 hours)|
|Strain on staff factor in terms of occupied beds||=|
|(full-time staff * 220 [working days per year] * 8 hours)|
The strain on staff factor based on the number of cases indicates, how many cases of treatment a full-timer has to care for in the annual average. The length of stay in a facility is not included in the calculation of this key number.
|Strain on staff factor in terms of cases||=|
Calculated in this manner the strain on staff factor refers only to fully-inpatient services. The outpatient and partly inpatient services as well as working hours exceeding the standard working hours remain unconsidered. Therefore the significance of this personnel load factor is limited.
The allocation of different professional designations to the functional groups corresponds mainly to the classification in the hospital bookkeeping regulations (KHBV - Krankenhaus-Buchführungsverordnung). School students and trainees are separately listed for information only with the "non-practitioner staff". Staff in care professions with certified further qualification as well as specialised hygiene staff are once again listed - independent of the functional groups.
Staff in training facilities
Staff in training facilities are teachers - also medical practitioners -, who have a contract for this job
Partly inpatients who have been discharged
Under "partly inpatients who have been discharged" the partly inpatients discharged from hospital during the reporting year (including partly inpatients who died) are reported with the specialized department where they were last located. In the case of partly inpatients treated at regular intervals (e.g. several partly inpatient dialysis treatments per week), a discharge is only recorded when the treatment as a whole is finished. Patients are classified as partly inpatient, if they get partly inpatient services according to § 13 section 1 BPflV (nursing care insurance) and if these are settled via a special rate for patient care ("Pflegesatz").
Child deliveries and births
Recorded are women, who have given birth in hospital in the reporting year, independent of the number of children born, as well as the number of women, who gave birth, by type of delivery (via forceps delivery, vacuum extraction delivery or caesarian section).
Finally, the number of children born in hospitals, including the number of children born alive or still is recorded in the Hospital statistics.
According to § 115b SGB V a catalogue for realisable outpatient operations and other ward substituting operations has to be agreed upon by the central organisations of the health insurance funds, the hospital association or the federal association of the hospital support organizations and of the National Association of Statutory Health Insurance Physicians. The hospitals are only allowed to perform outpatient operations and ward substituting operations according to the catalogue. An outpatient operation is characterized by the fact, that the patient does not spend the night before and after the operation in the hospital. If a hospitalization is necessary, for example due to complications, it is no longer an outpatient operation, but an inpatient case of treatment.
The Federal Health Monitoring System 22 Jun 2021