LSG Chemnitz: Cost advantages in hospitals are irrelevant
Cancer patients cannot easily choose inpatient chemotherapy. Outpatient treatment has priority as long as a hospital stay is not medically necessary, as the Saxon State Social Court (LSG) in Chemnitz decided in several judgments announced on Tuesday, August 1, 2017 (file number: L 12 KR 244/16 and others). After that, the costs are not important.
A hospital in the Chemnitz area had treated several patients with chemotherapy. The health insurance companies commissioned the medical service to review the treatments. After that, they refused to pay the costs. The hospital stays were not necessary.
With his lawsuit, the hospital argued that it was not foreseeable that the chemotherapy would go without complications. In addition, inpatient treatment is cheaper than outpatient treatment. Because the drugs obtained for outpatient treatments from a pharmacy are particularly expensive.
Like the Chemnitz Social Court, the LSG now dismissed the lawsuit. For reasons, it referred to the legal priority of outpatient treatment. If this was possible, the hospital was not entitled to remuneration according to the legal requirements. "This also applies if outpatient treatment for the health insurance company would have cost more than inpatient hospital treatment," emphasized the LSG.
There were no medical reasons for treatment in the hospital in the cases decided here. Therefore, it was "misallocations". The reason for the cost advantage of the hospitals is also the statutory price fixing of the public pharmacies, according to the LSG in its already published judgments of May 30, 2017. mwo / fle