No Evidence of Capacity Reporting Manipulation in Hospitals
ResearchZEW Study on Reported Number of Intensive Care Beds by Hospitals in COVID-19 Aid Payments
![[Translate to English:] Eine Person in einem weißen Kittel benutzt ein Tablet](/fileadmin/_processed_/7/3/csm_AdobeStock-ipopba_298001238_1200x1200_2c67300e85.jpg "ZEW Study on Reported Number of Intensive Care Beds by Hospitals")
Hospitals in Germany received financial support during the second and third waves of the coronavirus pandemic if they had a high occupancy of intensive care beds. However, suspicions were raised by the Federal Court of Auditors that hospitals may have manipulated the reported number of intensive care beds to obtain this support. Yet, a recent study by ZEW Mannheim shows that there is no empirical evidence to support this claim. Neither the distribution of reported available capacities nor their evolution over time exhibit significant anomalies.
The decrease in intensive care bed capacity during the aforementioned pandemic waves in Germany was more likely a result of the direct impact of the surge in COVID-19 cases rather than manipulated reports. “There is no empirical evidence to support the assertion that hospitals strategically reported a higher bed occupancy rate to gain additional financial aid,” says Dr. Simon Reif, head of the “Health Markets and Health Policy” Research Group at ZEW and co-author of the study. The ZEW researchers examined how hospitals responded to government financial support during the second and third waves of the pandemic from November 2020 to April 2021. One criterion for receiving payments was an occupancy rate of over 75 per cent for intensive care beds in a city or district – a metric that hospitals could directly influence. The Federal Court of Auditors, among others, had suggested the possibility of such capacity manipulation.
Payments saved hospitals from insolvency
The German healthcare system was unexpectedly hit by the COVID-19 pandemic in early 2020. This put the hospitals in a difficult financial position due to the case-based reimbursement scheme in Germany. On one hand, individuals postponed planned treatments out of fear of infection, resulting in fewer cases. On the other hand, hospitals were required to reserve capacity to accommodate the expected surge in COVID-19 cases. Without government intervention, the decline in patient numbers, accompanied by a drop in revenue, could have pushed hospitals to the brink of insolvency. To alleviate these financial difficulties, the government introduced aid programmes specifically for hospitals.
No anomalies in reported bed capacities
Government support payments in Germany were not only contingent upon available bed capacity but also tied to surpassing certain COVID-19 incidence levels. “If the reduction in available intensive care beds was a strategic response to qualify for support payments, there should have been a more pronounced decline in available beds when the COVID-19 incidence exceeded the threshold. However, no significant change in the number of reported available beds can be observed, nor are there any conspicuous patterns in the distribution of bed capacities that would suggest manipulation,” explains Sabrina Schubert, an economist in ZEW’s “Health Markets and Health Policy” Research Group and co-author of the study. The findings indicate that the scarcity of intensive care capacities during the second and third waves of the pandemic was directly driven by the surge in COVID-19 cases rather than strategic reporting. The study is the first to analyse publicly available data from various sources, including the Robert Koch Institute (RKI) for incidence data, the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) for intensive care register data, and hospital statistics from federal and state statistical offices.
Data access for scientific purposes must be improved
However, due to limited data access, the ZEW study cannot definitively dismiss the occurrence of manipulated reporting in isolated cases. “Many analyses of the German healthcare system lack comprehensive data access and the possibility to link data for scientific purposes,” says Dr. Simon Reif. “We need to obtain a better understanding of healthcare provision, not only during exceptional situations like the COVID-19 pandemic but also for the overall improvement of the healthcare system. However, this remains challenging due to the current data limitations.”
