German care reform act: Improving quality through transparency

The German care reform act, which came into force in 2008, introduced regularly audits of all inpatient and outpatient institutions in the care sector. Audit results are published through quality reports which intend to help persons in need of care make informed choices regarding care facilities. Audits are conducted by an independent institution to assure an objective and standardized approach. This study analyzed quality reports from 2009 to 2011 of 253 nursing homes of a large metropolitan area to evaluate the status-quo of quality of care. We focused on four major areas (care, provision of medical care, care of mentally ill patients, living and housekeeping) consisting of 64 items. Study findings suggest significant improvements concerning quality of care and service from 2009 to 2011 in all areas measured. While most institutions achieved best results in living and housekeeping, analysis revealed major needs for improvements regarding care and provision of medical care such as pain management, prevention of bedsore and muscle contractions, as well as wound care. In conclusion, study results imply that transparency regarding the quality of care facilities enabled customers to make informed choices. This in turn applied pressure on those institutions to distinguish themselves from competitors by enhancing quality of care and services. However, findings suggest that institutions primarily focus on areas that allow to improve audit results within a short space of time, e.g., housekeeping, rather than focusing on care-related processes – exactly those areas that can affect health status and may entail significant health care costs.