VORWORT I
VORWORT
=XUU 7KHPDWLN 0RGHUQH 3ODQXQJVVV XQG $QDO\VHPRGXOH NRQNUHWW GLH &RPSXWHUVLPXODWLRQ XQGG 6FKHGXOLQJZHUN]HXJH VLQG SUDNWLVFK HUSUREWH XQGG ZLVVHQVFKDIWOLFK IXQGLHUWH ,QVWUXPHQWH ZHOFKH ]X GUDVWLVFKHQ 9HU EHVVHUXQJHQKLQVLFKWOLFKGHUU(IIL]LHQ]]LQXQWHUVFKLHGOLFKVWHQ3UR]HVVHQQLP 3HUVRQDOHLQVDW] XQGG ]X GDUDXVV UHVXOWLHUHQGHQ .RVWHQUHGXNWLRQHQ LQQ :LUW VFKDIWVEHUHLFKHQ XQWHUVFKLHGOLFKVWHUU $UW EHLWUDJHQ N|QQHQQQ ,QQ %UDQFKHQ ZLHHGHU)HUWLJXQJVLQGXVWULHHHGHULQWHUQDWLRQDOHQ/RJLVWLNNRGHUGHV)OXJYHU NHKUVVVXPPQXUUGLHVH(LQVDW]JHELHWH]XXQHQQHQQQEHILQGHWWVLFKGLH6LPXODWL RQ LQ GHUU :LUWVFKDIWVZHOWW ]XX %HJLQQQGHVV-DKUKXQGHUWVV DXII(UIROJVNXUV XQGG ZLUGG IOlFKHQGHFNHQGG ]XUU 6\VWHPDQDO\VH DOVV 2SWLPLHUXQJVXQWHUVWW ]XQJHLQJHVHW]WW8QWHUQHKPHQVHKHQVLFKKLPPHUVWlUNHUZHUGHQGHPPJOR EDOHPP 'UXFN DXVJHVHW]W XQG ZHUGHQQ GD]X JH]ZXQJHQ HIIL]LHQW ]XX ZLUW VFKDIWHQQQ 'LH 6LPXODWLRQQ KLOIWW GDEHLL 3UR]HVVH EHVVHUU ]XX YHUVWHKHQ XQG ]X RUJDQLVLHUHQ 6\VWHPVFKZDFKVWHOOHQQ ]X ORNDOLVLHUHQ YHUVWHFNWH 5DWLRQDOL VLHUXQJVSRWHQWLDOH ]X HUNHQQHQ XQG .RVWHQQ ]X UHGX]LHUHQQ (VV ZLUG GDPLW JHOHUQWWYRUKDQGHQH5HVVRXUFHQQHIIL]LHQW]XQXW]HQ
$XFKLP*HVXQGKHLWVZHVHQEHVRQGHUVLP$XVODQGHUIUHXWVLFKGLH&RP SXWHUVLPXODWLRQ HQRUPP HUIROJUHLFKHUU XQG YLHOVHLWLJVWHU $QZHQGXQJ DOOHU GLQJVV NDXP LQQ gVWHUUHLFKKK 7URW]] GHUU VHLWW PHKUU DOVV -DKUHQQ EHNDQQWHQ .RVWHQH[SORVLRQ ZLUG GHU (LQVDW] VROFKHU :HUN]HXJH SUDNWLVFK QHJLHUW 'DVVKHLPLVFKH*HVXQGKHLWVV\VWHPPOHLGHWXQWHUGHPVWlQGLJ]XQHKPHQGHQ .RVWHQGUXFNVSH]LHOOLQGHQQ|IIHQWOLFKHQQ.UDQNHQDQVWDOWHQ,PPHUUGHXWOL FKHUZLUGGGLH7DWVDFKHGDVVVIXQGDPHQWDOH9HUlQGHUXQJHQQRWZHQGLJJVLQGG XP GLH H[]HOOHQWH XQG VR]LDO JHUHFKWH *HVXQGKHLWVYHUVRUJXQJJ DXFKK IU QDFKIROJHQGH *HQHUDWLRQHQQ ]X VLFKHUQ 0LWW 5HIRUPHQ XQG 1HXVWUXNWXULH UXQJHQLQQ2UJDQLVDWLRQXQG)LQDQ]LHUXQJJYHUVXFKWWGHUU6WDDWWGHUU.ULVHHQWW JHJHQ ]X ZLUNHQ 'LH 1RWZHQGLJNHLW GLHVHUU 5HIRUPHQ LVW XQEHVWULWWHQ GRFK GDPLW LVW GDV EUDFKOLHJHQGH (IIHNWLYLWlWVVWHLJHUXQJVSRWHQWLDO QRFK ODQJHHQLFKWDXVJHVFK|SIW'LHHYRUOLHJHQGH$UEHLWVROOO]HLJHQZHOFKHQ%HLL WUDJJ GLH 6LPXODWLRQQ PLWWHOV GHU 6\VWHPDQDO\VH ]XU (IIL]LHQ]VWHLJHUXQJJ LQ PHGL]LQLVFKHQQ 3UR]HVVHQQ OHLVWHQQ NDQQQ XQGG ZLH GLH EHWURIIHQHQQ 3HUVRQHQ JUXSSHQQ XQGG GLH KHLPLVFKHQ 6SLWlOHUU YRQ GHQQ GDUDXVV JHZRQQHQHQQ (U NHQQWQLVVHQQSURILWLHUHQ N|QQHQ(VZLUGGDQKDQG HLQHV 2336LPXODWLRQ3UR WRW\SVVGHPRQVWULHUWGDVVVPRGHUQH3ODQXQJVXQGG$QDO\VHPRGXOHLPVWDQQ
VORWORT II
GHVLQGHLQHQNHLQHVIDOOVEHODQJORVHQ$QWHLO]XU%HZlOWLJXQJGHU*HVXQG KHLWVNULVHEHL]XWUDJHQQQ
'LHYRUOLHJHQGH$UEHLWYHUVXFKWLQVEHVRQGHUHGDV0DQDJHPHQWGHUKHLPL VFKHQ .UDQNHQDQVWDOWHQQ ]X HUPXWLJHQ *HEUDXFK YRQ GHU &RPSXWHUVLPX ODWLRQDOVPlFKWLJH8QWHUVWW]XQJJ]XUU6\VWHPRSWLPLHUXQJJ]XPDFKHQQ'LH )KUXQJVHEHQHQ VLQG DQ GHU 5HLKH GHQ (LQVDW] PRGHUQHU ZLVVHQVFKDIWOLL FKHU 0HWKRGHQ XQG 7RROVV ]X IRUFLHUHQ GDV EUDFKOLHJHQGH 9HUEHVVHUXQJVV SRWHQWLDO DXV]XVFK|SIHQQQ GHQ .RVWHQGUXFN ]XX YHUULQJHUQQ XQGG GHP |VWHUU UHLFKLVFKHQ *HVXQGKHLWVZHVHQ HLQH QDFKKDOWLJHH =XNXQIW ]XX YHUVFKDIIHQQ 'LHYRUOLHJHQGH$UEHLWWVROO0RWLYDWLRQXQG$QOHLWXQJJGDIUOLHIHUQQ
=XP 9HUIDVVHUU 'HWDLOOLHUWH ,QIRUPDWLRQHQQ ]XPP 9HUIDVVHU GLHVHU $UEHLWW N|QQHQQGHPPDQJHIJWHQ/HEHQVODXIIDP(QGHGHUU$UEHLWHQWQRPPHQQZHU GHQQ
'DQNVDJXQJ =DKOUHLFKH 3HUVRQHQ KDEHQQ ]XPP (QWVWHKHQ GLHVHU $UEHLW EHLJHWUDJHQ $OOHQ YRUZHJJ JLOW PHLQ 'DQNN HLQHUU 3HUVRQ RKQHH GLHVHH GLH QDFKIROJHQGH $UEHLWW XQP|JOLFKK HQWVWHKHQQ KlWWH N|QQHQQQ 'U .DUO +HLQ] :HLJOKDWPLUUQLFKWQXUGLHH(KUHJHZlKUWPLWWLKP]XDUEHLWHQQVRQGHUQKDWW DXFKKGDVEHVFKULHEHQHH3URMHNWLQV/HEHQQJHUXIHQPHLQH$UEHLWIRUWODXIHQG XQWHUVWW]WW GLH IU GLH 6LPXODWLRQVVWXGLH Q|WLJHQ 5HVVRXUFHQQ ]XU 9HUI JXQJJ JHVWHOOWW XQGG QLFKWW ]XOHW]WW NRQQWH LFK PLU LQQ XQVHUHUU JHPHLQVDPHQ =XVDPPHQDUEHLW ]DKOUHLFKH XQGG VXEVWDQWLHOOH 'LQJH IU PHLQQ ]XNQIWLJHV /HEHQQPLWQHKPHQ±±YLHOHQQ'DQNGDIU
'DQN JHEKUW ZHLWHUVV +HUUQ ZHOFKHUU PLU LQ )UDJHQ
]XP *HVXQGKHLWVZHVHQ XQG VSH]LHOOO ]X GHQ |VWHUUHLFKLVFKHQQ .UDQNHQDQQ VWDOWHQYRUDOOHPDEHUEHLGHU(UIDVVXQJGHV2333UR]HVVHVVWHWVHLQH]XX YHUOlVVLJH$QVSUHFKSHUVRQQZDUUU$XHUGHPPGDQNHQGG]XHUZlKQHQQLVWW+HUU ZHOFKHUUPLUU GLH %HREDFKWXQJ HLQHUU+IWJHOHQNVLPSODQWDWLRQ
DPP $.++ :LHQQ HUP|JOLFKWH DQKDQGG GHUHU LFKK ZHVHQWOLFKH (UIDKUXQJHQ LP 23%HUHLFKHUODQJHQQNRQQWH
1LFKW ]XOHW]W P|FKWH LFK PHLQHU )DPLOLHHH PHLQHQ )UHXQGHQ XQGG PHLQHP :RKQXQJVNROOHJHQQ YRQQ JDQ]HP +HU]HQ IU GLH PHQWDOH 8QWHUVWW]XQJ ZlKUHQGGGHU(UVWHOOXQJGLHVHUU$UEHLWGDQNHQ
6WH\ULPP0DLLL
5REHUW$QGH[HU
INHALTSVERZEICHNIS III
INHALT
925 :257,
,1 /77,,,
,/'81 69(5 (, 1,66 9,
7$%(//(19(5=(,&+1,6 9,,
86 00(1) 6681 9,,,
675 77,
3UREOHPVWHOOXQJ
,QKDOWOLFKHU XIEDX
'HILQLWLRQHVVHQWLHOOHU HJULIIH
HVXQGKHLW
HVXQGKHLWVZHVHQ
HVXQGKHLWV NRQRPLH
'DV HVXQGKHLWVZHVHQLPJOREDOHQQ.RQWH W
OREDOH HWUDFKWXQJ
,QWHUQDWLRQDOHU9HUJOHLFK:LUWVFKDIWVVHNWRU HVXQGKHLWW
,QWHUQDWLRQDOHU9HUJOHLFK HVXQGKHLWV XVWDQG
'DV VWHUUHLFKLVFKHH HVXQGKHLWVZHVHQ
HVFKLFKWOLFKHU5 FNEOLFNN
)LQDQ LHUXQJXQG.RVWHQ
OOJHPHLQHV
2UJDQLVDWLRQQXQGG )LQDQ LHUXQJ
UDQNHQKDXVSUR HVVHH (LQ9HUJOHLFKK XX3URGXNWLRQVSUR HVVHQ
INHALTSVERZEICHNIS IV
OOJHPHLQHV
'HUU2333UR HVV
',(127:(1', (,79211237,0,(581 (1,00
(,0,6 (11 (681' (,76:(6(11
8UVDFKHQQ 'HUU:HJJLQGLH.ULVH
6R LDOGHPRJUDSKLVFKHH(QWZLFNOXQJ
( SORVLRQGHV0DFKEDUHQ
6WHXHUXQJVVXQG2UJDQLVDWLRQVIHKOHULQGHUU9HUJDQJHQKHLW
'LH HVXQGKHLWVUHIRUP (LQDPELWLRQLHUWHUUUDEHUUZHQLJJHIIHNWLYHU
QVDW
HJHQZlUWLJH6LWXDWLRQ
UJXPHQWHI UGHQ(LQVDW PRGHUQHU3ODQXQJVXQG QDO VHPRGXOH
(LQQ SSHOO
KDQFH XU3UREOHPHUNHQQXQJJI U0DQDJHUXQGG3HUVRQDO
'DWHQHUKHEXQJ
XWRPDWLVFKHH3UR HVVHUIDVVXQJ
UR HVDEHUUQRFKYHUVWHFNWHVXQGGXQHUNDQQWHV
2SWLPLHUXQJVSRWHQWLDOO
2333UR HVVRSWLPLHUXQJ
RVWHQ1XW HQ9HUKlOWQLVVGHUU6LPXODWLRQ
HHLQGUXFNHQGHLQWHUQDWLRQDOHH HQFKPDUNV
0HKUU*HOGI UDOWHUQDWLYHH1XW XQJ
(LQ XVZHJDXVVGH.UULVH
7 (25(7,6 (( 581'/ (1 8802'(51(1
3 / 181 66681'' 1 / 6(02'8/(11
'HILQLWLRQHVVHQWLHOOHU HJULIIH
6 VWHPP
0RGHOO
6LPXODWLRQ
RPSXWHUVLPXODWLRQ
6FKHGXOLQJ
QZHQGXQJ (LQVDW JHELHWHHXQG HGHXWXQJJGHU6LPXODWLRQ
'LH HVFKLFKWHGHUU6LPXODWLRQQ
(UIROJVIDNWRUHQQGHUU6LPXODWLRQVWHFKQRORJLHH
6LPXODWLRQVDUWHQ
3UR HVVHLQHU6LPXODWLRQVVWXGLH
'LHH XNXQIWGHU RPSXWHUVLPXODWLRQQ (LQQ XVEOLFN
0RWLYDWLRQ
3URMHNW LHO
INHALTSVERZEICHNIS V
LHOJUXSSH
9RUDXVVHW XQJHQGH.UUDQNHQDQVWDOWHQQ
3URMHNWSODQ
' 567(//81 '(56,08/ 7,216678',(
'DWHQHUKHEXQJXQGG0RGHOOHQWZLFNOXQJ
(QWZLFNOXQJGHVV0RGHOONRQ HSWV
0RGHOOLPSOHPHQWDWLRQ
0RGHOOYDOLGLHUXQJ
6WDWLVWLVFKH9HUVXFKVSODQXQJJXQGG'XUFKI KUXQJJGHU( SHULPHQWH
Q DKO6LPXODWLRQVOlXIHH 9HUWUDXHQVEHUHLFK
)DNWRUHQXQG QWZRUWHQ
( SHULPHQWHXQG(UJHEQLVVH
'LHH DXSWHIIHNWH
'LHH(UJHEQLVVH
,QWHUSUHWDWLRQGHUU(UJHEQLVVH
1
ABBILDUNGSVERZEICHNIS
ABBILDUNGSVERZEICHNIS
ABBILDUNG 1: INHALTLICHER AUFBAU DER ARBEIT
ABBILDUNG 2: GRAFISCHE DEFINITION DER GESUNDHEITSÖKONOMIE
ABBILDUNG 3: ORGANISATIONSSTRUKTUR DES ÖSTERREICHISCHEN
GESUNDHEITSWESENS
ABBILDUNG 4: TYPISCHES ORGANIGRAMM EINES STANDARDKRANKENHAUSES IN
DEN 80ER JAHREN
ABBILDUNG 5: VERWALTUNGSBEREICHE EINES ALLGEMEINEN KRANKENHAUSES
IN DER GEGENWART
ABBILDUNG 6: DER OP-PROZESS
ABBILDUNG 7: GRAFISCHE DEFINITION DES SYSTEMBEGRIFFS
ABBILDUNG 8: GRAFISCHE DEFINITION EINES MODELLS
ABBILDUNG 9: MODELLTYPEN NACH BIETHAHN
ABBILDUNG 10: EIGENSCHAFTEN EINES SIMULATIONSMODELLS
ABBILDUNG 11: DER PROZESS EINER SIMULATIONSSTUDIE
ABBILDUNG 12: DAS GANTT CHART ZUM DURCHGEFÜHRTEN PROJEKT
ABBILDUNG 13: REDUZIERTER SIMULATIONSPROZESS
ABBILDUNG 14: DIE SYSTEMGRENZE DES SIMULATIONSMODELLS
ABBILDUNG 15: RELATIVE HÄUFIGKEITEN DER OP-KLASSEN 2002
ABBILDUNG 16: RESTRIKTIONEN BEZÜGLICH DER PROZESSZEITEN AUF GRUND
VORHANDENER DATENBASIS
ABBILDUNG 17: PATIENTENEIGENSCHAFTEN - GESCHLECHT
ABBILDUNG 18: PATIENTENEIGENSCHAFTEN - ALTERSGRUPPEN
ABBILDUNG 19: PATIENTENEIGENSCHAFTEN - GEWICHTSKLASSEN
ABBILDUNG 20: PATIENTENANKUNFTSZEITEN
ABBILDUNG 21: DIE MODELLARCHITEKTUR
ABBILDUNG 22: ANIMATION DES OP-MIX IM MODELL.
ABBILDUNG 23: ANIMATION DER ERSTELLTEN OP-SIMULATION
TABELLENVERZEICHNIS VII
TABELLENVERZEICHNIS
TABELLE 1: GESUNDHEITSAUSGABEN IN DES BIP IN AUSGEWÄHLTEN LÄNDERN
AB 1970 11
TABELLE 2: LEBENSERWARTUNG DER MÄNNLICHEN BEVÖLKERUNG IN EUROPA
UND AUSGEWÄHLTEN AUßEREUROPÄISCHEN STAATEN 13
TABELLE 3: LEBENSERWARTUNG DER WEIBLICHEN BEVÖLKERUNG IN EUROPA
UND AUSGEWÄHLTEN AUßEREUROPÄISCHEN STAATEN 14
TABELLE 4: GESCHICHTE DES ÖSTERREICHISCHEN GESUNDHEITSWESENS. 19
TABELLE 5: ANZAHL DES MEDIZINISCHEN FACHPERSONALS 1970 BIS 2001. 20
TABELLE 6: ANZAHL PERSONAL AUS AUSGEWÄHLTEN BERUFSGRUPPEN IM
GESUNDHEITSWESEN NACH BUNDESLÄNDER ZUM 31. DEZEMBER
2001 21
TABELLE 7: GESUNDHEITSAUSGABEN IN ÖSTERREICH LAUT OECD/VGR -KONZEPT
(ESVG 95) VON 1997 BIS 2002, IN MIO EURO 25
TABELLE 8: ZAHL DER KRANKENANSTALTEN UND SYSTEMISIERTE BETTEN IN
ÖSTERREICH SEIT 1980 (STAND JEWEILS ZUM 31. DEZEMBER) 28
TABELLE 9: AUFBAU DER ÖSTERREICHISCHEN BEVÖLKERUNG NACH
ALTERSGRUPPEN (IN PROZENT) - STAND 2000 UND PROGNOSEN FÜR
2015 UND 2030 39
TABELLE 10: NATÜRLICHE BEVÖLKERUNGSBEWEGUNG IN ÖSTERREICH IN DEN
JAHREN 1970 BIS 2030 39
TABELLE 11: SIMULATIONSUNTERSTÜTZUNG IM BETRIEBLICHEN
ENTSCHEIDUNGSPROZESS (QUELLE: DR. WEIGL) 61
TABELLE 12: DAS KERNPROJEKTTEAM 68
TABELLE 13: ALTERNATIVE ANWENDUNGSMÖGLICHKEITEN DER SIMULATION IM
KRANKENHAUSBEREICH 70
TABELLE 14: STRUKTUR DER ZUGRUNDE LIEGENDEN MS ACCESS DATENBANK 74
TABELLE 15: STRUKTUR DER DATENBANK NACH ANALYSE UND FILTERUNG 75
TABELLE 16: PROZESS DER DATENFILTERUNG 76
TABELLE 17: DER INTRAOPERATIVE PROZESS 79
TABELLE 18: KLASSIFIZIERUNG DER EINGRIFFSARTEN 80
TABELLE 19: PERSONALBELEGUNG PRO OP-TYP 83
TABELLE 20: OP-TYP-KLASSEN-MATRIX 84
TABELLE 21: FAKTOREN UND DEREN EINTEILUNG 94
TABELLE 22: DEFINIERTE ANTWORTEN 94
TABELLE 23: FAKTORENKOMBINATIONEN 95
TABELLE 24: ANTWORTEN OPERIERTE PATIENTEN 95
TABELLE 25: ANTWORTEN DURCHSCHNITTLICHE OP-AUSLASTUNG. 96
TABELLE 26: HAUPTEFFEKTE DER FAKTOREN AUF DIE ANTWORTEN 97
ZUSAMMENFASSUNG VIII
ZUSAMMENFASSUNG
'DVV |VWHUUHLFKLVFKHH *HVXQGKHLWVZHVHQ EHILQGHW VLFK VHLW PHKU DOV ]ZHL -DKU ]HKQWHQ LQ )LQDQ]LHUXQJVVFKZLHULJNHLWHQ 'LHH JHVXQGKHLWOLFKHH 9HUVRUJXQJ LQQ XQVHUHP/DQGGLVWWYRQH[]HOOHQWHU4XDOLWlWWWDOOHUGLQJVVVDXFKKDXI*UXQGGNRPSOH [HU (QWZLFNOXQJHQ GHPHQWVSUHFKHQGG WHXHU 9RU DOOHP GLH |IIHQWOLFKHQQ .UDQQ NHQDQVWDOWHQ VLQGG YRQQ GHUU .RVWHQH[SORVLRQQ VWDUN EHWURIIHQQ XQGG NlPSIHQ JH JHQQ ,QHIIL]LHQ]HQQLQ GHQ VHOWHQQ HLQHU ZLUWVFKDIWOLFKHQQ %HWUDFKWXQJJ XQWHU]RJH QHQQ3UR]HVVHQQQ'LH6LPXODWLRQVWHFKQRORJLHLVWW]XX%HJLQQQGHVV-DKUKXQGHUWVV HQRUPP DXVJHUHLIW XQGG NDQQQ HLQHQQ EHDFKWOLFKHQ %HLWUDJ ]XU 9HUEHVVHUXQJJ GHU 3UR]HVVHXQGGGHU2UJDQLVDWLRQQLQQHUKDOEEGHV*HVXQGKHLWVV\VWHPVOHLVWHQQZLH GLHVLQQDQGHUHQQ/lQGHUQVHLWYLHOHQQ-DKUHQGHPRQVWULHUWWZLUG
$XIJDEH GLHVHU $UEHLWW ZDU HV PLWWHOV HLQHV VWDQGDUGLVLHUWHQQ 6LPXODWLRQVPR GHOOVVVHLQHQOHGLJOLFKILNWLYYHQWZLFNHOWHQ23DOVVHKUNRVWHQLQWHQVLYHQ%HUHLFKK LP .UDQNHQKDXV DE]XELOGHQ XQGG ]XX GHPRQVWULHUHQQ ZLH GLH 6LPXODWLRQQ XQG 6FKHGXOLQJZHUN]HXJH GRUW GLH (IIHNWLYLWlWVVWHLJHUXQJJ XQGG .RVWHQUHGXNWLRQ XQGGIROJOLFKKHLQH6\VWHPRSWLPLHUXQJJXQWHUVWW]HQQN|QQHQQQ=XX%HJLQQZHUGHQ GDV*HVXQGKHLWVZHVHQ XQGGVSH]LHOOGLH.UDQNHQDQVWDOWHQHLQHUJOREDOHQQ$QDD O\VHH XQWHU]RJHQ ,P $QVFKOXVVV IROJW HLQH 8QWHUVXFKXQJ GHUU 8UVDFKHQ IU GLH .RVWHQNULVHHXQGHLQHH$UJXPHQWDWLRQIUGLH1RWZHQGLJNHLWGHVV(LQVDW]HVPRR GHUQHU 3ODQXQJV XQGG $QDO\VHPRGXOH LQQ gVWHUUHLFKV 6SLWlOHUQQ XPP VFKOLHOLFK DXIGLH6LPXODWLRQXQGGDV6FKHGXOLQJLPWKHRUHWLVFKHQ.RQWH[WHLQ]XJHKHQ
+HU]VWFNGHUU$UEHLWWVWHOOWPLWWHOVGHUUREMHNWRULHQWLHUWHQQ6LPXODWLRQVVRIWZDUH Ä$5(1$³³HQWZLFNHOWHV6LPXODWLRQVPRGHOODOV3URWRW\SHLQHU236LPXODWLRQGDU 0RGHOOLHUW XQG DQDO\VLHUW ZLUG GDEHL GHU LQWUDRSHUDWLYH 3UR]HVV DOV ]HQWUDOHU XQGG UHVVRXUFHQLQWHQVLYVWHUU 7HLO GHU .UDQNHQKDXVSUR]HVVODQGVFKDIWW 'DV 0R GHOOEDVLHUWDXINHLQHPPJHJHQVWlQGOLFKKH[LVWLHUHQGHQQ5HDOV\VWHPZLUGMHGRFK PLWW LQQ HLQHPP |VWHUUHLFKLVFKHQ .UDQNHQKDXV HUKREHQHQ UHDOHQ ,QSXWGDWHQ JHVSHLVW 1HEHQQ GHU GHWDLOOLHUWHQQ %HVFKUHLEXQJJ GHU WHFKQLVFKHQ 8PVHW]XQJJ ZLUG DQKDQG GLHVHV 0RGHOO3URWRW\SV JH]HLJW ZLH GXUFK 6\VWHPDQDO\VH PLW WHOV GHU 6LPXODWLRQQ GDV 6\VWHPYHUKDOWHQQ DQDO\VLHUW XQGG (IIHNWLYLWlWVVWHLJH UXQJVSRWHQWLDOH PLWWHOV ([SHULPHQWHQQ HUNDQQW ZHUGHQ N|QQHQQ 'LH LPP =XJH GHU([SHULPHQWHXQWHUVXFKWHQQ(UJHEQLVSDUDPHWHUVLQGGHU3DWLHQWHQGXUFKVDW] XQGG GLH GXUFKVFKQLWWOLFKH 23$XVODVWXQJJ EHUU GHQ 6LPXODWLRQV]HLWUDXPP 'LH (UJHEQLVVHXQWHUVWUHLFKHQQGHQQ1XW]HQGLHVHU7HFKQRORJLHQIUGDV|VWHUUHLFKL VFKHH*HVXQGKHLWVZHVHQXQGVROOHQGD]XEHLWUDJHQ+HPPQLVVHHEH]JOLFKGHVV SUDNWLVFKHQ(LQVDW]HVVGLHVHU7RROVV]XUHGX]LHUHQ
ABSTRACT IX
ABSTRACT
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
7KH SXUSRVH RI WKLV WKHVLV LV WR RXWOLQH WKH SRVVLELOLWLHV RI VLPXODWLRQ DQG VFKHGXOLQJJ WRROV E\\ GHYHORSLQJJ DD VLPXODWLRQ PRGHO SURWRW\SHH RI DD ILFWLWLRXV VXUJHU\ GHSDUWPHQW DV D YHU\ FRVW LQWHQVLYH SDUW RI WKH KRVSLWDO DQG VKRZ KRZZ WKHVHH LQVWUXPHQWVV FDQ OHDG WRR LQFUHDVH LQQ HIILFLHQF\\\ FRVW UHGXFWLRQ DQG VXSSRUW V\VWHPP RSWLPLVDWLRQ 6WDUWLQJ ZLWKK DD WKHRUHWLFDO RYHUYLHZ DERXWW WKH KHDOWKK FDUH V\VWHP DQGG SDUWLFXODUO\\ DERXWW KRVSLWDOV WKLV WKHVLV LQYHVWLJDWHV WKHUHDVRQVIRUWKHILQDQFLDOOFULVLVDQGGLVFXVVHVWKHHVVHQWLDOOQHHGVRIPRG HUQQ SODQQLQJJ DQGG DQDO\VLQJJ PRGXOHV IRU WKHH QDWLRQDOO PHGLFDO V\VWHP EHIRUH H[DPLQLQJWKRVHHWRROVVRQWKHEDVLVRIFXUUHQWOLWHUDWXUHH
$VWKHHFRUHHRIWKLVWKHVLVWKHWHFKQLFDOGHYHORSPHQWWDQGGDQDO\VLVRIWKHVXU JHU\ GHSDUWPHQWW VLPXODWLRQ SURWRW\SH LV GHVFULEHG 7KH PRGHO ZDV UHDOLVHG ZLWKWKHLQWHUQDWLRQDOZHOONQRZQµ$5(1$¶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
7KHVLPXODWLRQVWXG\\KLJKOLJKWVWKHSRVVLEOHEHQHILWVRIPRGHUQSODQQLQJJDQGG DQDO\VLQJJPRGXOHVIRUWKH$XVWULDQQSXEOLFKHDOWKKV\VWHP ,W VKRXOGGRYHUFRPH LQKLELWLRQVWRZDUGWKHSUDFWLFDOXVHRIWKHVHSRZHUIXOWHFKQRORJLHVZKLFKFDQ FHUWDLQO\VXSSRUWHIIRUWVWRILQGDZD\RXWRIWKHFULWLFDOVLWXDWLRQLQRXUPHGL FDOV\VWHP
1 EINLEITUNG SEITE 1
1 EINLEITUNG
1.1 PROBLEMSTELLUNG
'DVKHLPLVFKH*HVXQGKHLWVZHVHQGDV]XGHQEHVWHQQZHOWZHLWJHK|UWWEH ILQGHWVLFKKVHLW-DKU]HKQWHQQLQGHU.ULVH$OO]XXUHJHOPlLJEHULFKWHQQ3ROLWL NHU 0HGLHQ XQG ([SHUWHQ EHU GHQQ NULWLVFKHQQ =XVWDQG GHUU VWDDWOLFKHQQ *HVXQGKHLWVYHUVRUJXQJ .RPSOH[H (QWZLFNOXQJHQ XQGG IHKOHQGH *HJHQQ PDQDKPHQQLQGHU9HUJDQJHQKHLWKDEHQGLH.RVWHQQEHUSURSRUWLRQDODQQ VWHLJHQQ ODVVHQ 'LH .RVWHQH[SORVLRQ LQQ |IIHQWOLFKHQQ 6SLWlOHUQ 3HUVRQDO PDQJHOO XQG GLH GDUDXV UHVXOWLHUHQGHH hEHUEHDQVSUXFKXQJ GHUU 0LWDUEHLWHUU IKUHQ ]X 5HLEXQJVYHUOXVWHQ LQ GHU *HVXQGKHLWVYHUVRUJXQJ XQG ]ZLQJHQQ GHQ 6WDDWW ]X UDGLNDOHQ 5HIRUPHQ )ROJOLFK ZLUG GDV 3URGXNW Ä*HVXQGG KHLW³³LPPHUWHXUHUXQGGLHVVWULIIWDOOOMHQHGLHHDXIIVWDDWOLFKH*HVXQGKHLWV YHUVRUJXQJDQJHZLHVHQVLQG
:RDEHUUOLHJHQQGLH8UVDFKHQQIUUGLHVH(QWZLFNOXQJHQQXQGGYRUUDOOHPPPZHO FKHU ,GHHQ ,QVWUXPHQWH RGHUU 0HWKRGHQ EHGDUI HVVV XPP GLHVHQQ HQWVSUHH FKHQGG ]X EHJHJQHQ" )XQGDPHQWDOHQ (LQIOXVV DXII GLH VFKZLHULJH 6LWXDWLRQ KDWW PLWW 6LFKHUKHLW GLH VR]LDOGHPRJUDILVFKH (QWZLFNOXQJ LQQ gVWHUUHLFKKK 'LH %HY|ONHUXQJVVWUXNWXUEHILQGHWVLFKLP:DQGHOO'LHH*HEXUWHQUDWHLVWUFNN OlXILJXQGGLH/HEHQVHUZDUWXQJVWHLJWWW'LHVVEHGHXWHWWWGDVVVLPPHUUZHQLJHU 6WHXHU]DKOHU HLQHQ VWlQGLJ VWHLJHQGHQQ PHGL]LQLVFKHQQ %HGDUI ILQDQ]LHUHQ PVVHQQQQLFKWW]XOHW]WWGXUFKKGLHUDSLGHhEHUDOWHUXQJXQVHUHUU*HVHOOVFKDIWW 'RFK QLFKW QXU GLHH VR]LDOHQ 6WUXNWXUHQ EHHLQIOXVVHQQ GHQ =XVWDQGG GHV *HVXQGKHLWVV\VWHPVV XQGG GHVVHQQ =XNXQIW 'LH UDVDQWW YRUDQVFKUHLWHQGH PHGL]LQLVFKHXQGPHGL]LQWHFKQLVFKH(QWZLFNOXQJJELHWHWLPPHUPHKUU0|JJ OLFKNHLWHQQ ]XUU %HKDQGOXQJ NUDQNHU 0HQVFKHQQ Ä([SORVLRQQ GHVV 0DFKED UHQ³ 6RPLWHQWVWHKWGHUU=ZDQJJJGLHVHH(QWZLFNOXQJHQGHQÄ*HVXQGKHLWV NRQVXPHQWHQ³³ DXFK ]XJlQJOLFK ]X PDFKHQ ,QYHVWLWLRQHQ LQ 0LOOLDUGHQ K|KH VLQGG GLH )ROJHHH 'HQQ EHLGHQ VRHEHQ HUZlKQWHQQ 8UVDFKHQ XQG DXFKK DQGHUHQ 3UREOHPHQ ZLHH EHLVSLHOVZHLVH GHP VWlQGLJJ ]XQHKPHQGHQQ 'UXFN GHVV LQWHUQDWLRQDOHQQ:HWWEHZHUEHV ZLUGQXUVHKUVFKZHUDNWLYEHJHJQHQ ]X VHLQQQ (LQHU ZHLWHUHQQQ IXQGDPHQWDOHQ 8UVDFKH NDQQ MHGRFKK VHKU ZRKO
9JOO2EHUHQGHUU)OHLVFKPDQQ6
9JOOHEHQGDD6
1 EINLEITUNG SEITE 2
DNWLYYHQWJHJHQJHVWHXHUWWZHUGHQGLHVHELUJW]XGHPHLQXQKHLPOLFKOXNUDD WLYHVV3RWHQWLDOXPPGLHKHLNOH6LWXDWLRQ]XHQWVFKlUIHQQ
'LH 5HGH LVW YRQ GHQ KLVWRULVFK YHUDOWHWHQQ 2UJDQLVDWLRQVVWUXNWXUHQQQ GHP QRFK XQ]XUHLFKHQGG HIIHNWLYHQZLUWVFKDIWOLFKHQQ +DQGHOQQ XQGGGHUU HUVW ODQJJ VDPP HUNHQQEDUHQQ 3UR]HVVRULHQWLHUXQJJ XQGG YHUEHVVHUXQJJ LQQ GHQQ |IIHQWOL FKHQ .UDQNHQDQVWDOWHQQQ 'LH VWDDWOLFKHQ 6SLWlOHUU YHUVFKOLQJHQQ VHLW MHKHU IDVW GLH +lOIWHH GHU *HVDPWJHVXQGKHLWVDXVJDEHQQ XQG VWHOOHQ VRPLWW GHQQ JU|WHQQ.RVWHQEORFNNLP|VWHUUHLFKLVFKHQQ*HVXQGKHLWVZHVHQGDU ZHVKDOE HV QDKH OLHJW PLWW GHU 3UREOHPO|VXQJJ GRUWW DQ]XVHW]HQQQ %LV GDWR ZXUGHQ NDXP LQQRYDWLYHH 0DQDJHPHQWNRQ]HSWH DXVV DQGHUHQ :LUWVFKDIWV]ZHLJHQQ DGDSWLHUWYRP(LQVDW]PRGHUQHUU3ODQXQJVXQGG$QDO\VHPRGXOHDOVVPlFK WLJH7RROVV]XU8QWHUVWW]XQJGHU6\VWHPRSWLPLHUXQJZDULQgVWHUUHLFKKELV ]XPP JHJHQZlUWLJHQ =HLWSXQNWW NDXP ]XX K|UHQQ 3RVLWLY LVW DQ]XPHUNHQQ GDVV DXI %XQGHVHEHQH ]XPLQGHVW HUNDQQW ZXUGH GDVV DXFKK LP *HVXQGG KHLWVZHVHQXQGVSH]LHOOLQGHQ|IIHQWOLFKHQQ6SLWlOHUQDXIIPRGHUQH.RQ]HS WHDXVGHU3ULYDWZLUWVFKDIWW]XUFNJHJULIIHQZHUGHQPXVVV6RZDUUHLQQZLFK WLJHUU (FNSIHLOHU GHUU LQ .UDIW JHWUHWHQHQ *HVXQGKHLWVUHIRUP GLH (LQQ IKUXQJJ GHUU 4XDOLWlWVVLFKHUXQJJ LQQ GHQQ VWDDWOLFKHQQ .UDQNHQDQVWDOWHQ XQGG GDPLWW HLQQ HUVWHU 6FKULWW LQQ 5LFKWXQJ 3UR]HVVGHQNHQXQGG 3UR]HVVYHUEHVVH UXQJJHWDQ=XGHPPSRVLWLY]XEHZHUWHQLVWWGHUUHUVWMXQJH*HGDQNH.UDQ NHQKlXVHUDOVV8QWHUQHKPHQQDQ]XVHKHQQXQGGGLHVHXQWHUSULYDWZLUWVFKDIWOL
1LFKWVV GHVWR WURW] IXQNWLRQLHUWW EHLVSLHOVZHLVH GHU 2SHUDWLRQVSUR]HVVVV DOV WHXHUVWHUU %HUHLFKK LQ HLQHP .UDQNHQKDXVV VHLW -DKUHQ QRFKK LPPHU IDVW LGHQWLVFKK3UR]HVVHZHUGHQQNDXPKLQWHUIUDJWRGHUEHZXVVWJHPDQDJWWXQG (IIHNWLYLWlWVYHUEHVVHUXQJHQ ILQGHQQ NDXPP VWDWWW E]Z VWHKHQQ QLFKWW LP 0LW WHOSXQNW GHUU 0DQDJHPHQWIXQNWLRQ LP *HVXQGKHLWVZHVHQ )ROJOLFKK LVWW GLH .DSD]LWlWVDXVODVWXQJ HLQHV GXUFKVFKQLWWOLFKHQ |VWHUUHLFKLVFKHQ 23V ZHQLJ ]XIULHGHQVWHOOHQGXQGOLHJWWHLOZHLVHZHLWWXQWHUUGHUUU3UR]HQW0DUNH
8PGHU.ULVHLPP|VWHUUHLFKLVFKHQ*HVXQGKHLWVV\VWHPHIIHNWLY]XEHJHJQHQ VLQG Y|OOLJJ QHXH $QVlW]HH XQG ,GHHQ JHIRUGHUW (LQHQQ YLHOO YHUVSUHFKHQGHQ %HLWUDJJNDQQKLHU]XXGHUU(LQVDW]PRGHUQHU3ODQXQJVVVXQG$QDO\VHPRGXOHLQQ GHQQ |IIHQWOLFKHQQ .UDQNHQDQVWDOWHQ OHLVWHQ LQ GHQHQ (LQVSDUXQJHQQ JHQH ULHUWW GXUFKK 6\VWHPRSWLPLHUXQJHQQ PLWWHOVV 8QWHUVWW]XQJJ HUZlKQWHU ,QQ
9JO+RIPDUFKHU5DFNNNN6666
9JOOHEHQGDD6 9JOOHEHQGDD
1 EINLEITUNG SEITE 3
VWUXPHQWHIXQGDPHQWDOHXQGGSRVLWLYH9HUlQGHUXQJHQQLP|VWHUUHLFKLVFKHQ *HVXQGKHLWVZHVHQ ]XU )ROJH KDEHQ N|QQHQ (V OLHJW EHLP 0DQDJHPHQW GHUU .UDQNHQKlXVHUU GLHVH &KDQFH ]XX HUNHQQHQQQ GLH .RVWHQQ ]X UHGX]LHUHQ XQGG GLH (IIL]LHQ] LQ GHQ 3UR]HVVHQQ ]X VWHLJHUQQQ XPP GHQQ VFKZLHULJHQQ 5DKK PHQEHGLQJXQJHQ RSWLPLVWLVFKK EHJHJQHQ ]X N|QQHQQ XQGG DXFKK LQQ =XNXQIW HLQH GHUDUW KRFKZHUWLJH XQG YRU DOOHPP ILQDQ]LHUEDUH *HVXQGKHLWVYHUVRUU JXQJJLQQgVWHUUHLFK]XHUP|JOLFKHQQ
1.2 ZIELSETZUNG
'HUUVR]LDOGHPRJUDILVFKHQ(QWZLFNOXQJJLQQgVWHUUHLFKZLUGGQXUVHKUUVFKZHU HQWJHJHQ]XZLUNHQ VHLQQ XQGG DXFK GHU =ZDQJ QHXDUWLJVWH WHFKQRORJLVFKH (QWZLFNOXQJHQ DXI]XJUHLIHQQ XQGG HLQ]XVHW]HQ ZLUG QLFKW QDFKODVVHQQQ E]Z GLHVHH ]X LJQRULHUHQ ZlUH HLQ VFKOHFKWHUU $QVDW] ]XUU 6LFKHUXQJ GHUU KHLPLL VFKHQ *HVXQGKHLWVYHUVRUJXQJJJ'HUU 6FKOVVHO ]XUU %HZlOWLJXQJJGHUUKHLNOHQ 6LWXDWLRQ OLHJW EHLL GHQ 9HUDQWZRUWOLFKHQQ GHUU |IIHQWOLFKHQ 6SLWlOHUUU HJDOO RE EHLL 3ROLWLNHUQ .UDQNHQKDXVEHWULHEVJHVHOOVFKDIWHQ GHP DOOJHPHLQHQ 0D QDJHPHQWRGHUULQWHUQHQ.RPPLVVLRQHQ]XU4XDOLWlWVVLFKHUXQJJHVLVWWGH UHQQ $XIJDEH GDV EUDFKOLHJHQGHH HQRUPP KRFK HLQ]XVFKlW]HQGHH .RVWHQUH GXNWLRQV XQGG (IIL]LHQ]VWHLJHUXQJVSRWHQWLDO ZDKU]XQHKPHQQ XQGG DXFK ]X QXW]HQ
:lKUHQGG GLHVH (UNHQQWQLVVH LQQ gVWHUUHLFKK ODQJVDPP *HVWDOWW DQQHKPHQ GLHVLVWXQWHUUDQGHUHPDQGHU*UQGXQJJYRQGLYHUVHQ$XVELOGXQJVHLQULFKK WXQJHQ LP 7KHPHQIHOG GHU *HVXQGKHLWV|NRQRPLH XQG GHV *HVXQGKHLWV PDQDJHPHQWVV ]X HUNHQQHQQQ LVW HLQH 7HFKQRORJLH LP =XVDPPHQKDQJ PLW GHQ |VWHUUHLFKLVFKHQ 6SLWlOHUQ XQG GHUHQ )KUXQJVHEHQHQQ QRFK HLQH ZH QLJJEHNDQQWH'LH&RPSXWHUVLPXODWLRQ9HUJOHLFKHQZLUUGLH:LFKWLJNHLW XQGG *U|H GHVV *HVXQGKHLWVZHVHQVV PLWW MHQHUU GHUU )HUWLJXQJV RGHU /RJLV WLNLQGXVWULH VR LVW HVV HUVWDXQOLFKK GDVVV GLH 6LPXODWLRQ NHLQHQQ DQQlKHUQG lKQOLFKHQ 6WHOOHQZHUW HLQQLPPWW 6LPXODWLRQ EHVLW]W GDV 3RWHQWLDO HLQH ZLFKWLJH 5ROOH LQQ GHU (QWVFKHLGXQJVILQGXQJ YRQ 3UR]HVVHQQ LP *HVXQGG KHLWVZHVHQ HLQ]XQHKPHQ ,QHIIL]LHQ]HQQ ]X HUNHQQHQQ XQGG 2SWLPLHUXQJV P|JOLFKNHLWHQQ HUIROJUHLFKK ]X SODQHQQ XQG GXUFK]XIKUHQQQ ,QWHUQDWLRQDO ZXUGHQ GXUFK GHQ (LQVDW]] GHU 6LPXODWLRQ VFKRQ VHKU KRKH 5DWLRQDOLVLH UXQJVSRWHQWLDOH LPP *HVXQGKHLWVZHVHQ ORNDOLVLHUW ± gVWHUUHLFK VROOO GLHVHQ %HLVSLHOHQIROJHQQ
1 EINLEITUNG SEITE 4
'LHH SDUDOOHOO ]XU (UVWHOOXQJ GLHVHU $UEHLW GXUFKJHIKUWHH 6LPXODWLRQVVWXGLH 2336LPXODWLRQVSURWRW\SSSEHVFKlIWLJWVLFKPLWWGHUU'DWHQHUKHEXQJJJ'DWHQ VWUXNWXUHQ0RGHOONRQ]HSWHQXQGGHU0RGHOOLHUXQJYRQ23VVDOVVWHXHUVWHQ %HUHLFK HLQHVV .UDQNHQKDXVHV 23V DUEHLWHQQ LP 0RPHQW ZLH EHUHLWVV HUU ZlKQW VHKU LQHIIL]LHQWW GDV KHLW GLH $XVODVWXQJJ PXVV DXV .RVWHQ XQGG %HGDUIVJUQGHQ HUK|KW ZHUGHQQ ,P 5DKPHQ GLHVHU $UEHLW VROOO PLW +LOIH HLQHVV 236LPXODWLRQVSURWRW\SVV XQWHUVXFKW XQG GHPRQVWULHUWW ZHUGHQ ZLH VLFKK3DWLHQWHQQQE]Z2SHUDWLRQVDXINRPPHQQXQGG2SHUDWLRQVPL[[XQWHU(LQ VDW]]YHUVFKLHGHQHUU%HOHJXQJVVWUDWHJLHQXQGGPLWWHOVVDQGHUHUUH[SHULPHQWDD OHUU9HUlQGHUXQJHQQLP6\VWHPPDXIIGLH(IIL]LHQ]GHVNOLQLVFKHQQ23%HUHLFKHV DXVZLUNHQQQ (VV ZHUGHQ ZHLWHUVV $VSHNWH XQGG (LQVDW]IHOGHU GHV 6FKHGXOLQJV DXFKLQQ.RPELQDWLRQQPLWWGHUU6LPXODWLRQDOVK\EULGHV3ODQXQJVVVXQG$QDO\ VHLQVWUXPHQW EHKDQGHOWWW (LQIOVVH XQWHUVFKLHGOLFKHUU )DNWRUHQ XQG GHUHQ $XVZLUNXQJHQQ DXII GHQ 3DWLHQWHQGXUFKVDW] VRZLH GLH $XVODVWXQJ YRQ 23V N|QQHQQVRXQWHUVXFKWZHUGHQQ
0LWGHUUYRUOLHJHQGHQ$UEHLWVROOGLH]XNQIWLJZLFKWLJH5ROOHHGHUU&RPSXWHU VLPXODWLRQLPPQDWLRQDOHQ*HVXQGKHLWVZHVHQGHPRQVWULHUWWZHUGHQXPHLQ 8PGHQNHQ LPP 0DQDJHPHQW ]XX JHQHULHUHQ HLQHQQ 3DUDGLJPHQZHFKVHO DQQ ]XVWRHQXQGGHU.RVWHQNULVHDQQLKUHQQ:XU]HOQQ]XEHJHJQHQQ
1.3 INHALTLICHER AUFBAU
'HUU $XIEDXX GHU YRUOLHJHQGHQ $UEHLWW IROJW HLQHP NODU VWUXNWXULHUWHQQ XQG ORJLVFKHQQ .RQ]HSW =XQlFKVWW ZLUG GDV *HVXQGKHLWVZHVHQ DOV $UEHLWVXPP IHOG XQGG GLH .UDQNHQDQVWDOWHQ E]Z GHUU 23 LPP VSH]LHOOHQQ EHKDQGHOWWW 'LH EHUHLWVV NXU] DQJHVSURFKHQHQ 3UREOHPH LP |VWHUUHLFKLVFKHQ *HVXQGKHLWV V\VWHP ZHUGHQ GDQQ LP 'HWDLOO DXIJH]HLJW XQG GLHH 1RWZHQGLJNHLW YRQ 2SWLPLHUXQJHQQXQWHUVWULFKHQQ,PP$QVFKOXVVIROJWWHLQHNXU]H(LQIKUXQJLQ GLHH7KHRULHGHUPRGHUQHQQ3ODQXQJVXQG$QDO\VHPRGXOHH'HUYHUEOHLEHQ GH 7HLOO VWHOOW GHQ .HUQ GHUU $UEHLWW GDUU XQGG EHIDVVWW VLFKK DXVVFKOLHOLFKK PLW GHU NRQNUHW GXUFKJHIKUWHQ 6LPXODWLRQVVWXGLH E]Z GHU (QWZLFNOXQJ GHVV 2336LPXODWLRQVSURWRW\SVVVGHQGDUDXVVJHZRQQHQHQ(UJHEQLVVHQQXQGGHUHQ P|JOLFKHQQ%HQHILWVIUGDVKHLPLVFKH*HVXQGKHLWVZHVHQQ
$EELOGXQJ ]HLJW HLQHH Ä/DQGNDUWH³³ GHU 6WUXNWXU E]ZZ GHQQ ÄURWHQ )D GHQ³ GXUFK GLH $UEHLWW LQNOXVLYH P|JOLFKHU )UDJHQ DXVV 6LFKWW GHV /HVHUVV ZHOFKH PLWWHOV NXU]HQ hEHUEOLFNV EHUU GLH HLQ]HOQHQQ .DSLWHO EHDQWZRUWHW ZHUGHQ
2 DAS GESUNDHEITSWESEN SEITE 6
2 DAS GESUNDHEITSWESEN - EIN ÜBERBLICK
*HJHQZlUWLJHVV .DSLWHO EHWUDFKWHWW GDVV *HVXQGKHLWVZHVHQ DXVV PDNUR|NR QRPLVFKHUU3HUVSHNWLYH%HJULIIH%HUXIVJUXSSHQKLVWRULVFKH+LQWHUJUQGH (QWZLFNOXQJHQXQG6WUXNWXUHQLPP*HVXQGKHLWVV\VWHPZHUGHQREHUIOlFKOLFKK LPLQWHUQDWLRQDOHQQYRUDOOHPPDEHULPPQDWLRQDOHQ.RQWH[WEHKDQGHOW(VLVW HUIRUGHUOLFK GDV *HVXQGKHLWVV\VWHP JUREE DEHU JDQ]KHLWOLFK ]XX HUIDVVHQ XP(LQEOLFNNLQGDVV$UEHLWVXPIHOGGXQGGLHVHQQEHGHXWHQGHQQ:LUWVFKDIWVVHN WRUU]XHUODQJHQQ
2.1 DEFINITION ESSENTIELLER BEGRIFFE
'LH %HWUDFKWXQJJ GHVV NRPSOH[HQQ *HELHWHV GHU *HVXQGKHLWVYHUVRUJXQJJ EH GDUI ]XQlFKVW HLQHU 'HILQLWLRQ JUXQGOHJHQGHU %HJULIIHHH *HJHQZlUWLJHU $E VFKQLWWELHWHWHLQHDOOJHPHLQJOWLJH%HVFKUHLEXQJGHUU%HJULIIH*HVXQGKHLWW *HVXQGKHLWVZHVHQ XQG *HVXQGKHLWV|NRQRPLH XPP GHQQ (LQVWLHJ LQQ GLH 7KHPDWLN]XHUOHLFKWHUQ
2.1.1 GESUNDHEIT
(LQHODLHQKDIWH%HWUDFKWXQJJGHVV*HVXQGKHLWVEHJULIIHVN|QQWHIROJHQGH'H ILQLWLRQ]XODVVHQQQ'LH*HVXQGKHLWWLVWWHLQQ3DUDPHWHUUIUUGHQQSK\VLVFKHQXQG SV\FKLVFKHQQ =XVWDQGG HLQHVV 0HQVFKHQ 7DWVlFKOLFKK DEHU OlVVWW VLFKK GHUU %H JULIII VHKU YLHOO ZHLWHU IDVVHQQQ 'LH :+2 GHILQLHUWHH LQ LKUHU 9HUIDVVXQJ YRQQ GHQQ *HVXQGKHLWVEHJULIII LQ HLQHU .XU]GHILQLWLRQ DOVV HLQHQ Ä=XVWDQGG YROONRPPHQHQ N|USHUOLFKHQQQ JHLVWLJHQ XQG VR]LDOHQ :RKOEHILQGHQV³ XQGG QLFKWWEORDOVHLQÄ)HKOHQQYRQQ.UDQNKHLWWXQG*HEUHFKHQQ³
$XVGLHVHUU'HILQLWLRQNDQQQEHUHLWVVDEJHOHLWHWZHUGHQQQGDVVGLH*HVXQGKHLW DQQVLFKKPHKUXPIDVVWWDOVVQXUUGHQQN|USHUOLFKHQQXQGGJHLVWLJHQ=XVWDQGGHL QHVV0HQVFKHQ1HEHQQGHQQODLHQKDIWWDQJHQRPPHQHQ)DNWRUHQQGHUUN|USHUU OLFKHQQ XQGG SV\FKLVFKHQ *HVXQGKHLWW VSLHOW DOVR DXFKK GDVV VR]LDOH 8PIHOG E]ZZGLHHVR]LDOHH6WHOOXQJHLQH5ROOHHhEHUGUHLLJ-DKUHQDFKGHUUJHWURIIH QHQQ 'HILQLWLRQ GHU :+2 HUZHLWHUWH GLHVH GHQ *HVXQGKHLWVEHJULII ]XVlW] OLFK XP GLHH 'LPHQVLRQHQ gNRORJLHH XQGG /HEHQVVLQQ =XVDPPHQIDVVHQG NDQQDOVRIHVWJHKDOWHQZHUGHQQQGDVVVGHUU%HJULIII*HVXQGKHLWLQQHLQHUJDQ]
:HOWJHVXQGKHLWVRUJDQLVDWLRQQQ
85/KWWSSSSJHVXQGKHLWWGJEEEZWWGHHGHILQLWLRQKWPOO>@@ 9JOO+D\HQ3DHWRZ6FKXPDFKHUU6
2 DAS GESUNDHEITSWESEN SEITE 7
KHLWOLFKHQQ %HWUDFKWXQJ NHLQHVIDOOVV QXU GHQ N|USHUOLFKHQQ XQGG SK\VLVFKHQ =XVWDQG HLQHV 0HQVFKHQ VRQGHUQ DXFK VHLQQ VR]LDOHVV :RKOEHILQGHQ DOVR 6WHOOHQZHUWXQG$QHUNHQQXQJLPVR]LDOHQ8PIHOGGLH|NRORJLVFKH8PJH EXQJJGHV0HQVFKHQQVRZLHZHLWHUH(LQIOXVVIDNWRUHQQXPIDVVWW
2.1.2 GESUNDHEITSWESEN
$XFKK EH]JOLFKK GLHVHV :RUWJHEUDXFKVV N|QQHQQ 0XWPDXQJHQQ DQJHVWHOOW XQGGVHKUSDXVFKDOOEHKDXSWHWZHUGHQGDVVGDVV*HVXQGKHLWVZHVHQDOOOMHQH (LQULFKWXQJHQQ XQGG 3HUVRQHQ XPIDVVW GLH VLFKK LQQ LUJHQGHLQHUU )RUP GHP +HLOHQQ YRQQ .UDQNKHLWHQQ XQGG GHU *HVXQGKHLWVI|UGHUXQJ ZLGPHQQQ 'LH WDW
8QJOHLFK DEHU lKQOLFKK OlVVWW VLFK GDV *HVXQGKHLWVZHVHQ DOV Ä*HVDPWKHLWW DOOHUU(LQULFKWXQJHQQ]XUU(UIOOXQJPHGL]LQLVFKHU$XIJDEHQQLQGHQQ%HUHLFKHQQ 3UlYHQWLRQ'LDJQRVWLN7KHUDSLH1DFKVRUJHXQGG5HKDELOLWDWLRQ³ FKDUDNN WHULVLHUHQ
2.1.3 GESUNDHEITSÖKONOMIE
'HU DQJHIKUWH %HJULII VHW]W VLFK DXV GHQ $XVGUFNHQ *HVXQGKHLW XQG gNRQRPLH ]XVDPPHQQ 'DUDXV NDQQ JHVFKORVVHQ ZHUGHQ GDVV GLH *HVXQGKHLWV|NRQRPLHHVRZRKOGLHH%HGHXWXQJGHU*HVXQGKHLWZLHHYRUDQJHH KHQGGHILQLHUWDOVVDXFKGLHgNRQRPLHH]XVDPPHQIKUW*DQ]RKQH%HUFN VLFKWLJXQJJGHUJOWLJHQ'HILQLWLRQXQGGHVWDWVlFKOLFKHQ*HJHQVWDQGHVGHU *HVXQGKHLWV|NRQRPLH NDQQ GLH 7KHVH HQWZLFNHOWW ZHUGHQ GDVV VLFKK HU ZlKQWHV)DFKJHELHWWPLWWGHPP8PJDQJJGHU*HVXQGKHLWWGHUU0HQVFKHQXQWHUU %HUFNVLFKWLJXQJ GHV |NRQRPLVFKHQ 3ULQ]LSV EHVFKlIWLJW :LUG GHU %HJULII GHVV *HVXQGKHLWVZHVHQVV QXQ DXFK LQ GLH %HWUDFKWXQJ PLWHLQEH]RJHQQQ VR N|QQWH HLQH P|JOLFKH 'HILQLWLRQ GHUU *HVXQGKHLWV|NRQRPLH DOVV 6FKOXVVIRO JHUXQJZLHIROJWODXWHQQQ'LH*HVXQGKHLWV|NRQRPLHXQWHUVXFKWWGLH=LHOVHWW ]XQJ PLWWHOV HLQHV GHILQLHUWHQ 5HVVRXUFHQDXIZDQGHV HLQHQ PD[LPDOHQ *HVXQGKHLWV]XVWDQGGHU%HY|ONHUXQJJ]XXJHQHULHUHQRGHUUHLQHQQJHZQVFK
85/KWWSSZZZXQLNOOGH)%%LRORJLHH$*=DQNOOOOVOGGGKWPP>@ 85/KWWSSZZZLPVHHPHGGWXPXHQFKHQGHHPLLWKHRUPHGG*,$NWHXUHHKWPP >@
2 DAS GESUNDHEITSWESEN SEITE 8
WHQQ E]ZZ JHIRUGHUWHQQ *HVXQGKHLWV]XVWDQG GHU %HY|ONHUXQJJ PLWW P|JOLFKVWW JHULQJHP0LWWHODXIZDQG]XUHDOLVLHUHQQ
'LHVH ODLHQKDIWW HQWZLFNHOWH 'HILQLWLRQ LVW UHODWLY JXW JHOXQJHQQ GHQQ WDWW VlFKOLFKK EHVFKlIWLJWW VLFKK GLH *HVXQGKHLWV|NRQRPLH PLW GHU |NRQRPLVFKHQ
HUVLFKWOLFKKKGDUJHVWHOOWZHUGHQ
$EELOGXQJJJ*UDILVFKH'HILQLWLRQQGHU*HVXQGKHLWV|NRQRPLH
%UH\HUU XQG =ZHLIHO VWHOOHQQ ]XVlW]OLFKK GLH )UDJH ZDUXP VLFK gNRQRPHQ PLWW GHP *HVXQGKHLWVZHVHQ EHIDVVHQ XQG IKUHQQ GLHVV DXI GLHH EHUHLWV HU ZlKQWHH.ULVHLQEHVDJWHPP6\VWHP]XUFNN6RPLWWEHZHJWWVLFKYRUOLHJHQGH $UEHLWWDXIIGHP*HELHWWGHUU*HVXQGKHLWV|NRQRPLHGDDYHUVXFKWWZLUGPLWWHOV PRGHUQHQ 0DQDJHPHQWWRROVVV ZLH GHU 6LPXODWLRQQ XQGG
6FKHGXOLQJZHUN]HXJHQ GLH (IIHNWLYLWlWVVLWXDWLRQ LQQ HLQHPP VSH]LILVFKHQ %HUHLFKK GHVV *HVXQGKHLWVZHVHQVV LQWUDRSHUDWLYHU %HUHLFK ]X DQDO\VLHUHQQ GDU]XVWHOOHQQXQGGLQIROJHHGHVVHQ]XYHUEHVVHUQ
2.2 DAS GESUNDHEITSWESEN IM GLOBALEN KONTEXT
2.2.1 GLOBALE BETRACHTUNG
,Q QDKH]X MHGHPP 6WDDW GLHVHUU (UGH JLEW HVV HLQH $UW *HVXQGKHLWVV\VWHPP E]ZYHUVRUJXQJ+LQVLFKWOLFK$XVSUlJXQJ2UJDQLVDWLRQ6WUXNWXU)LQDQ ]LHUXQJJXQGGDQGHUHQQ5DKPHQEHGLQJXQJHQQJLEWWHVVHUKHEOLFKH8QWHUVFKLHGH
9JOO+D\HQ3DHWRZ6FKXPDFKHUU6
*UDIYRQGHUU6FKXOHQEXUJ.LHOKRUQ*UHLQHUU9ROPHUU6 9JOO+D\HQ3DHWRZ6FKXPDFKHUU6 9JOO%UH\HUU=ZHLIHOO6
2 DAS GESUNDHEITSWESEN SEITE 9
1XUZHQLJH/lQGHUGLHVHU(UGHHELHWHQGHU%HY|ONHUXQJHLQHHYHUJOHLFKEDUH *HVXQGKHLWVYHUVRUJXQJ ZLH GDVV HWZD LQQ gVWHUUHLFK GHU )DOOO LVW 8PP GLH *HVXQGKHLWVV\VWHPH HLQ]HOQHUU 6WDDWHQ GLHVHU (UGH ]X YHUJOHLFKHQ XQG JURE]XHUIDVVHQZLHHGLHVHH6\VWHPHHLQYHUVFKLHGHQVWHQ1DWLRQHQRUJDQL VLHUWWVLQGELHWHWW+DMHQ HLQHVHKUQW]OLFKH.ODVVLIL]LHUXQJJJ'HPQDFKODVV VHQQVLFKKJUXQGVlW]OLFKKGUHL7\SHQYRQQ*HVXQGKHLWVV\VWHPHQQXQWHUVFKHLGHQ
'DVZHWWEHZHUEOLFKHH *HVXQGKHLWVV\VWHP'LH*HVXQGKHLWVHLQULFK WXQJHQVLQGGIDVWDXVVFKOLHOLFKKLQSULYDWHUU+DQGGRGHUULP(LJHQWXPPYRQ 1RQQ3URILW2UJDQLVDWLRQHQQ *HVXQGKHLWVOHLVWXQJHQ ZHUGHQ DP ÄIUHLHQ 0DUNW³DQJHERWHQXQGGHU.RQVXPHQWHQWVFKHLGHWVHOEVWEHUU9RUVRUJH XQGG 8PIDQJ GHU 1XW]XQJJ HQWVSUHFKHQGHU /HLVWXQJHQ 'LHVHV 6\VWHP JOHLFKW DQGHUHQ :LUWVFKDIWVEHUHLFKHQ XQG JLOW DOV HIIL]LHQWW LQQRYDWLY MHGRFKK ZHQLJ JHUHFKWW 3HUVRQHQQ GLH VLFKK NHLQH 9HUVLFKHUXQJ OHLVWHQ N|QQHQQPVVHQDXII/HLVWXQJHQYHU]LFKWHQ/lQGHULQQGHQHQQGLHVHU6\VV WHPW\SYRUKHUUVFKWVLQGEHLVSLHOVZHLVHHGLH86$$XQGGLHH6FKZHL]]
'DV VWDDWOLFKH *HVXQGKHLWVV\VWHP 'LH *HVXQGKHLWVHLQULFKWXQJHQ VLQG ]XP *URWHLO LQ VWDDWOLFKHU +DQG XQGGZHUGHQQ EHU6WHXHUQ ILQDQ ]LHUW 'LHH HLQ]HOQHQ /HLVWXQJHQ ZHUGHQ JHQDX GHILQLHUW VWDQGDUGLVLHUW XQGGNDONXOLHUW'HU6WDDWNRQWUROOLHUWGDVV$QJHERWXQGGLHH4XDOLWlWGHUU 9HUVRUJXQJ6WDDWOLFKH6\VWHPHVLQGGVHKUJHUHFKWWMHGRFKKVRZLHYLHOH VWDDWOLFKH%HWULHEHDXFKZHQLJJHIIL]LHQWWXQGGLQQRYDWLYYY5HSUlVHQWDWLYH /lQGHUU IU GDV VWDDWOLFKHH 6\VWHP VLQGG XQWHUU DQGHUHPP *UREULWDQQLHQ ,WDOLHQQQ*ULHFKHQODQGGG6FKZHGHQXQG6SDQLHQQ
'DVV NRUSRUDWLVWLVFKHH 6R]LDOYHUVLFKHUXQJVV\VWHP'LHVHUU6\VWHPP W\S EDVLHUW DXI GHPP 3ULQ]LSS GHU 3IOLFKWYHUVLFKHUXQJ 'LH %HLWUlJH ]XU 6R]LDOYHUVLFKHUXQJORKQDEKlQJLJZHUGHQYRQVLFKKVHOEVWYHUZDOWHQGHQ .UDQNHQNDVVHQ HLQJHKREHQ 'LHVHH SODQHQ DXFK $QJHERW 4XDOLWlW XQGG 3UHLVH IU GDV 6\VWHP 'LH *HVXQGKHLWVHLQULFKWXQJHQ VLQG VRZRKO LQ SULYDWHP DOVV DXFK LQ VWDDWOLFKHP (LJHQWXP 'DV NRUSRUDWLVWLVFKH 6R ]LDOYHUVLFKHUXQJVV\VWHP 6\VWHP NDQQQ HQWZHGHUU $XVZLUNXQJHQQ GHVV ZHWWEHZHUEOLFKHQQ HIIL]LHQWWW DEHUU ZHQLJJ JHUHFKWWWW DOVV DXFK GHV VWDDWOL FKHQ6\VWHPVJHUHFKWWWDEHUUZHQLJHIIL]LHQWWXQGGLQQRYDWLYYYDXIZHLVHQ 'LHVHU 6\VWHPW\S KHUUVFKW LQ gVWHUUHLFK XQG ZHLWHUHQ 6WDDWHQ ZLH 'HXWVFKODQGGGGLH1LHGHUODQGH%HOJLHQQ)UDQNUHLFKKXQGG-DSDQYRUU
9JOO+D\HQ3DHWRZ6FKXPDFKHUU6I
2 DAS GESUNDHEITSWESEN SEITE 10
2KQHWLHIJHKHQGHUDXIGLH(UIDVVXQJXQGG(YDOXLHUXQJGHUU*HVXQGKHLWVV\VV WHPH GLHVHUU (UGH HLQ]XJHKHQQQ PLW GLHVHUU $XIJDEH EHVFKlIWLJWW VLFK GLH VR JHQDQQWH *HVXQGKHLWVV\VWHPIRUVFKXQJJJ HLQH 7HLOGLV]LSOLQ GHU *HVXQGG KHLWV|NRQRPLH VROOHQGLHH8QWHUVFKLHGHHGHUUPHGL]LQLVFKHQ9HUVRUJXQJJLQ HLQ]HOQHQ 6WDDWHQ XQVHUHUU :HOW XQWHUVWULFKHQQ ZHUGHQ 'LH (LQOHLWXQJ LP 2YHUYLHZZ GHV Ä:RUOG +HDOWK 5HSRUW ³³ GHU :+22 ]LWLHUW GLHH .OXIW ]ZLL VFKHQ$UPXQG5HLFK]ZLVFKHQQH[]HOOHQWHUXQGVRRJXWWZLHHNHLQHUUPHGL]LL
'LHVHU$XV]XJJ]HLJWWGLH8QWHUVFKLHGHGHUJOREDOHQ*HVXQGKHLWVYHUVRUJXQJ DXIIEHVRQGHUVVWUDJLVFKH$UWWXQG:HLVH(VHUVFKHLQWQXUUDOO]XXYHUVWlQGOLFKK GDVV(QWZLFNOXQJVOlQGHUUXQGG/lQGHUGHUÄ'ULWWHQQ:HOW³NHLQRGHUQXUZH QLJ*HOGIUGLH*HVXQGKHLWLKUHU%HY|ONHUXQJ]XU9HUIJXQJVWHOOHQN|Q QHQQ :LFKWLJ LVW GDV %HZXVVWVHLQQ GDVV gVWHUUHLFKK WURW]] GHU VFKZLHULJHQ ILQDQ]LHOOHQQ XQGG VWUXNWXUHOOHQQ 6LWXDWLRQQQ HLQH H[]HOOHQWH JHVXQGKHLWOLFKH 9HUVRUJXQJDXIZHLVWWWDXIIGHUHQ(QWZLFNOXQJJGLH%HY|ONHUXQJVWRO]XQGIU GHUHQQ9RUKDQGHQVHLQQGDQNEDUUVHLQVROOWH
2.2.2 INTERNATIONALER VERGLEICH - WIRTSCHAFTSSEKTOR GESUNDHEIT
(VV LVW EHUHLWVVEHNDQQWW GDVVV GLH *HVXQGKHLWVV\VWHPH YHUVFKLHGHQHU 6WDD WHQLQGUHL7\SHQQNDWHJRULVLHUWZHUGHQN|QQHQQQ'LH$XVSUlJXQJJGHU6WHO OHQZHUWXQGGLHH%HGHXWXQJJGHVV:LUWVFKDIWVVHNWRUV*HVXQGKHLWWLQHLQ]HOQHQ /lQGHUQLVWWMHGRFKQXUUVHKUVFKZHU]XHUIDVVHQRGHUU]XYHUJOHLFKHQ=ZDUU N|QQHQQ EHVWLPPWH .HQQZHUWH JHJHQEHUU JHVWHOOW ZHUGHQQQ GLH $XVVDJH NUDIWW EHU GHQ WDWVlFKOLFKHQQ =XVWDQGG GHU *HVXQGKHLWVYHUVRUJXQJJ LQ HQW
9JOO+D\HQ3DHWRZ6FKXPDFKHUU6
85/KWWSSZZZZKRLQWZKUHQRYHUYLHZBHQSGI>@
2 DAS GESUNDHEITSWESEN SEITE 11
VSUHFKHQGHQQ /lQGHUQ LVW MHGRFK EHJUHQ]WW 8UVDFKHQ IUU GLH VFKZLHULJH ,QWHUSUHWDWLRQXQG9HUJOHLFKEDUNHLWWN|QQHQXQWHUUDQGHUHPPVHLQ
8QWHUVFKLHGOLFKH*HVXQGKHLWVEHJULIIVGHILQLWLRQHQ
*UHQ]]LHKXQJ]ZLVFKHQQ*HVXQGKHLWVXQG6R]LDOZHVHQ 8QWHUVFKLHGOLFKH'DWHQTXHOOHQ 8QWHUVFKLHGOLFKVWH2UJDQLVDWLRQVVWUXNWXUHQGHU6\VWHPH %UFKHLQQGHQQ=HLWUHLKHQMlKUOLFKH(UIDVVXQJHWF
'HVVHQ XQJHDFKWHWW ORKQW VLFK GLHH 8QWHUVXFKXQJ DQNQSIHQGHUU 7DEHOOH LQ GHU GLHH $XVJDEHQ LP %HUHLFK GHV *HVXQGKHLWVZHVHQV YHUVFKLHGHQVWHU /lQGHULQGHV%,3DQJHJHEHQVLQGG'LHVH.HQQ]DKOLVWHLQLQWHUQDWLRQDO DQHUNDQQWHUU ,QGLNDWRU IUU GLH $XVSUlJXQJJ GHVV *HVXQGKHLWVZHVHQVV YHUU VFKLHGHQHUU/lQGHUQQ
7DEHOOH*HVXQGKHLWVDXVJDEHQQLQGHV%,3LQDXVJHZlKOWHQQ/lQQ GHUQDEE
9JOO6WDWLVWLN$XVWULDDD-DKUEXFKGHUU*HVXQGKHLWVVWDWLVWLN2QOLQHLPP:::: XQWHU85/KWWSZZZVWDWLVWLNDWQHXHUVFKHLQXQJHQJHVXQGKHLWVKWPO >@
2 DAS GESUNDHEITSWESEN SEITE 12
'LH86$$$JHIROJWWYRQQGHUU6FKZHL]]]XQG'HXWVFKODQG EULQJWPLWDP%,3LP-DKUPLW$EVWDQGDPPHLVWHQ
ILQDQ]LHOOH 0LWWHO IUU GDV *HVXQGKHLWVZHVHQ DXII $PP XQWHUHQQ (QGH GHU $XVJDEHQWDEHOOH VLHGHOQQ VLFKK GLH 6ORZDNHL 8QJDUQ 0H[LNR .RUHDD XQG /X[HPEXUJ DQ gVWHUUHLFK OLHJW PLW 6WDDWHQ ZLH 1HXVHHODQGG 'lQHPDUNN 6FKZHGHQRGHU,WDOLHQQLPLQWHUQDWLRQDOHQ0LWWHOIHOGGG'LHH9HUPXWXQJJJGDVV PLW KRKHQQ *HVXQGKHLWVDXVJDEHQ XQEHGLQJW HLQH KRKH /HEHQVHUZDUWXQJ DOVV,QGLNDWRUUGHVV*HVXQGKHLWV]XVWDQGHVHLQHU%HY|ONHUXQJJJHLQKHUJHKWWWLVW PLW9RUVLFKW]XJHQLHHQ7DEHOOHXQGVLHKH.DSLWHOYHUJOLFKHQ PLWGHQQ:HUWHQDXVREHQQYLVXDOLVLHUWHU7DEHOOHEHOHJHQGLHVH$XVVDJH
2.2.3 INTERNATIONALER VERGLEICH - GESUNDHEITSZUSTAND
(LQ ZLFKWLJHU ,QGLNDWRUU IU GHQQ *HVXQGKHLWV]XVWDQGG GHU %HY|ONHUXQJ LVW GHUHQ/HEHQVHUZDUWXQJ-HlOWHUGLH(LQZRKQHUHLQHU1DWLRQZHUGHQGHVWR JHVQGHUOHEHQGLHVHXQGGHVWREHVVHUXQGXPIDQJUHLFKHULVWGHP]XIROJH GLHPHGL]LQLVFKH9HUVRUJXQJJ
9JOO6WDWLVWLN$XVWULDDD-DKUEXFKGHUU*HVXQGKHLWVVWDWLVWLN2QOLQHLPP:::: XQWHU85/KWWSZZZVWDWLVWLNDWQHXHUVFKHLQXQJHQJHVXQGKHLWVKWPO >@
2 DAS GESUNDHEITSWESEN SEITE 13
7DEHOOH/HEHQVHUZDUWXQJGHUUPlQQOLFKHQ%HY|ONHUXQJLQQ(XURSD XQGDXVJHZlKOWHQDXHUHXURSlLVFKHQQ6WDDWHQ
,QIROJHGHVVHQQ NDQQ PLW JHZLVVHUU $XVVDJHNUDIWW HLQH %HZHUWXQJJ GHV *HVXQGKHLWVV\VWHPV HLQ]HOQHUU 6WDDWHQQDXII %DVLV GHUU/HEHQVHUZDUWXQJJ LK UHUU%HZRKQHUHUIROJHQQ
9JOO6WDWLVWLN$XVWULDDD-DKUEXFKGHUU*HVXQGKHLWVVWDWLVWLN2QOLQHLPP:::: XQWHU85/KWWSZZZVWDWLVWLNDWQHXHUVFKHLQXQJHQJHVXQGKHLWVKWPO >@
2 DAS GESUNDHEITSWESEN SEITE 14
$XHUHXURSlLVFKHH6WDDWHQ
-DSDQ .DQDGD 1HXVHHODQG 7UNHL 9HUHLQLJWH6WDDWHQ 7DEHOOH/HEHQVHUZDUWXQJGHUUZHLEOLFKHQ%HY|ONHUXQJLQQ(XURSD
7DEHOOHXQGJHEHQHLQHQhEHUEOLFNEHUGLHXQWHUVFKLHGOLFKHQ/HEHQV HUZDUWXQJHQQQ MHZHLOV GHU 0lQQHUU XQGG GHUU )UDXHQ LQQ GHQQ HXURSlLVFKHQ 6WDDWHQ VRZLH LQ DXVJHZlKOWHQ DXHUHXURSlLVFKHQQ 6WDDWHQ $QJHJHEHQ VLQGGLHH*HVDPWOHEHQVHUZDUWXQJVRZLHHGLHHYHUEOHLEHQGH/HEHQVHUZDUWXQJJ HLQQ-DKUXQG-DKUHQDFKKGHU*HEXUW(LQHSHQLEOH%HWUDFKWXQJ EHLGHU 7DEHOOHQ OlVVW GLH )RUPXOLHUXQJ XQWHQVWHKHQGHU $XVVDJHQ ]X GLH
9JOO6WDWLVWLN$XVWULDDD-DKUEXFKGHUU*HVXQGKHLWVVWDWLVWLN2QOLQHLPP:::: XQWHU85/KWWSZZZVWDWLVWLNDWQHXHUVFKHLQXQJHQJHVXQGKHLWVKWPO >@
2 DAS GESUNDHEITSWESEN SEITE 15
MHGRFKKPLW9RUVLFKWWJHWURIIHQQZHUGHQPVVHQGDDGLH6WHUEHWDIHOQDXVVGHQ MHZHLOLJHQ-DKUHQHWZDVVYRQHLQDQGHUDEZHLFKHQ
gVWHUUHLFK OLHJW PLW HLQHU /HEHQVHUZDUWXQJ YRQ -DKUHQ EHL GHQ
0lQQHUQXQG-DKUHQEHLGHQ)UDXHQQLPLQWHUQDWLRQDOHQQ6SLW]HQIHOGG 1XU 6FKZHGHQ GLHH 6FKZHL]]] $XVWUDOLHQ -DSDQ XQG .DQDGDD ZHLVHQ VR ZRKO EHLL GHQ 0lQQHUQ DOV DXFK EHLL GHQ )UDXHQ HLQH K|KHUHH /HEHQVHU ZDUWXQJJ DXIII 'LHVV VSLHJHOW GLHH KHUYRUUDJHQGHH PHGL]LQLVFKHH 9HUVRUJXQJ
(LQH lKQOLFKH RGHU IDVWW LGHQWLVFKH /HEHQVHUZDUWXQJ ZLH LQQ gVWHUUHLFK ]HLJW VLFK EHL GHQ *ULHFKHQ GHQ 1LHGHUOlQGHUQ GHQ 6SDQLHUQ XQG GHU %HY|ONHUXQJLQ*UREULWDQQLHQ
'LHH LQ .DSLWHOOJHWURIIHQHH$XVVDJH GDVV GLHH*HVXQGKHLWVDXVJDEHQQ HLQHVV 6WDDWHVVV JHPHVVHQQ LQ 3UR]HQW DPP %,33 QLFKWW XQEHGLQJWW PLWW GHP *HVXQGKHLWV]XVWDQG GHU MHZHLOLJHQ %HY|ONHUXQJ LQ =XVDPPHQKDQJ JHH EUDFKWZHUGHQN|QQHQQE]ZPLW9RUVLFKWW]XJHQLHHQQVHLNDQQQXQXQ WHUVWULFKHQQZHUGHQ'LH9HUHLQLJWHQQ6WDDWHQQJDEHQQLP-DKUPLWW$E VWDQGDPPHLVWHQ*HOGJHPHVVHQLQ3UR]HQWDP%,3IUGLHPHGL]LQL VFKH9HUVRUJXQJLKUHU%HY|ONHUXQJDXV7URW]GHPOLHJWGLH86$$PLWHL QHU/HEHQVHUZDUWXQJYRQ-DKUHQQEHLGHUUPlQQOLFKHQXQG-DK UHQQEHLGHUUZHLEOLFKHQ%HY|ONHUXQJKLQWHUUgVWHUUHLFKXQGGDQGHUHQ6WDDD WHQQQ ZHOFKH GHXWOLFKK ZHQLJHUU ILQDQ]LHOOH 0LWWHO JHPHVVHQQ DP %,3 IU GDVV*HVXQGKHLWVV\VWHP]XUU9HUIJXQJJVWHOOWHQ 'DVV ]ZLVFKHQ GHQQ *HVXQGKHLWVDXVJDEHQ HLQHVV 6WDDWHV XQG GHQ *HVXQGKHLWV]XVWDQGGHU(LQZRKQHUUMHGRFKKQDWUOLFKKHLQHJHZLVVH.RUUH ODWLRQQEHVWHKWEHZHLVWGLHH7UNHLLL0LWWQLFKWWHLQPDOGHUU*HVXQGKHLWV DXVJDEHQ DPP %,33 HUUHLFKWW HLQQ PlQQOLFKHUU 7UNH LP 'XUFKVFKQLWW DXFK QXUUHLQQ$OWHUYRQHLQH7UNLQYRQQXU-DKUHQ
%HVRQGHUVVQLHGLUJJLVWWGLH/HEHQVHUZDUWXQJJLQGHUUXVVLVFKHQQ)|GHUDWLRQ 0lQQHUU )UDXHQQ (V NDQQ DQJHQRPPHQ ZHUGHQQ GDVVV DXI *UXQGGHUDXHURUGHQWOLFKHQ*U|HHGLHVHV/DQGHVVGHQ]XVlW]OLFKHQQSR OLWLVFKHQ6FKZLHULJNHLWHQXQGGHUUWXUEXOHQWHQ9HUJDQJHQKHLWYLHOH0HQ VFKHQNHLQHQQRGHUQXUUEHJUHQ]WW=XJDQJJ]XXSURIHVVLRQHOOHUUPHGL]LQLVFKHU 9HUVRUJXQJ KDEHQ'LHV ]HLJW ]XVlW]OLFKKKGDVV 5XVVODQGGDXFK LQQGLHVHP :LUWVFKDIWVVHNWRUHUKHEOLFKH5FNVWlQGHDXI]XKROHQQKDWWWXPPGDVV1LYHDX YLHOHUZHVWHXURSlLVFKHU6WDDWHQQ]XXHUUHLFKHQ
2 DAS GESUNDHEITSWESEN SEITE 16
2.3 DAS ÖSTERREICHISCHE GESUNDHEITSWESEN
2.3.1 GESCHICHTLICHER RÜCKBLICK
=XQlFKVW QRFK YRU %HWUDFKWXQJ GHU MQJHUHQQ *HVFKLFKWH GHV |VWHUUHLFKL VFKHQ*HVXQGKHLWVZHVHQVVVLVWWHVYRQ,QWHUHVVHHLQHQ%OLFNNZHLW]XUFNN]X GHQ8UVSUQJHQ]XZHUIHQ8PGLH*HVFKLFKWHGHU*HVXQGKHLWVYHUVRUJXQJ YRQQ $QIDQJJ DQ DXI]XUROOHQQQ HLJQHWW VLFK ]XQlFKVWW HLQH $XVIKUXQJJ YRQ *XW]ZLOOHUUXQG-HDQQHUHW GLHPLWLKUHUU%HVFKUHLEXQJJGHU(QWVWHKXQJGHV *HVXQGKHLWVZHVHQVVLQGHU6FKZHL]]ZLHIROJWEHJLQQHQQ
'LHVEHOHJWW]XPPHLQHQGDVVVGLH8UVSUQJHGHVVKHXWLJHQQ*HVXQGKHLWVV\VV WHPV EHUHLWV VHKU ZHLW ]XUFNN LQ GHU 9HUJDQJHQKHLW ]XX ILQGHQ VLQG XQG ]XPP DQGHUHQQ GDVV ELV ]XU =HLWW GHV U|PLVFKHQ 5HLFKHVV GLH 0HGL]LQ DOV HWZDVPDJLVFKHVVXQGGLUUDWLRQDOHVVDQJHVHKHQZXUGH0RGHUQHH)RUPHQXQG *HVWDOWW QDKP GHPQDFK GLH *HVXQGKHLWVYHUVRUJXQJ LPP 0LWWHODOWHU DQQQ (LQ *HIKOXQG(LQEOLFNNLQGDVVGDPDOLJH6\VWHPPOLHIHUWWQDFKIROJHQGHUU$XV]XJ ,QWHUHVVDQWWKHUDXV]XOHVHQQLVWWGLH6WHOOXQJHLQHV$U]WHVVXQGGGHVVHQQ$XIJDD EHQ]XUGDPDOLJHQ=HLW
*XW]ZLOOHUU-HDQQHUHWW6
85/KWWSSZZZDVQ
LENDFDWWELOGXQJIDHFKHUUJHVFKLFKWHHPDLNHHPLWWHODOWHUU0D;KWPP>@
2 DAS GESUNDHEITSWESEN SEITE 17
2EHQVWHKHQGHU KLVWRULVFKHU $XV]XJ ELHWHW 6SLHOUDXP IU HLQLJHH KRFKLQWH UHVVDQWH7KHVHQQ
'HU *UXQGVWHLQ IU GDV KHXWH YRU]XILQGHQGH *HVXQGKHLWVZHVHQ ZXUGH EHUHLWVV LP 6SlWPLWWHODOWHU JHOHJWWW bU]WH ZXUGHQQ YRPP 5DWWW DOVR YRQQ GHU 6WDGWYHUZDOWXQJJ HLQJHVWHOOW XQG PXVVWHQ DXVQDKPVORV MHGHP NUDQNHQ 0HQVFKHQ LKUHH 'LHQVWHH DQELHWHQQQ 6RPLW NDQQ DQJHQRPPHQ ZHUGHQQ GDVV GLH *HVXQGKHLWVYHUVRUJXQJ VFKRQ VHKU IUK LQ GHU *HVFKLFKWH ÄVWDDWOLFKH³$QJHOHJHQKHLWZDUXQGVRZLHKHXWHIUDOOH]XJlQJOLFKVHLQ PXVVWH XQDEKlQJLJ YRPP VR]LDOHQ 6WDWXV %HY|ONHUXQJVVFKLFKWW RGHU (LQNRPPHQQ
$OV HUVWHVV $Q]HLFKHQ IU GLH (QWVWHKXQJJ GHVV KHXWLJHQQ 6R]LDOYHUVLFKH
UXQJVV\VWHPVVVPLWGHP *UXQGJHGDQNHQ MHGHP 0HQVFKHQQ HJDO ZHOFKHU (LQNRPPHQVJUXSSH HLQH DGlTXDWH PHGL]LQLVFKH 9HUVRUJXQJJ ]X JDUDQ WLHUHQ NDQQ GLH 3IOLFKW GHV 0HGLFXV DUPH 0HQVFKHQ NRVWHQORV ]X YHU VRUJHQLQWHUSUHWLHUWWZHUGHQ
:HLWHUHH3DUDOOHOHQ]ZLVFKHQGHP0LWWHODOWHUXQGGHU*HJHQZDUWN|QQHQ IROJHQGHUPDHQKHUJHVWHOOWWZHUGHQQQ'LH3IOLFKWWGHVV0HGLFXVVVMHGHXQJH Z|KQOLFKH.UDQNKHLWVRIRUW]XPHOGHQQQJOHLFKWGHQKHXWLJHQJHVHW]OLFKHQ 5HJHOXQJHQ ]XU (LQJUHQ]XQJJ XQGG %HNlPSIXQJJ YRQQ (SLGHPLHQQQ 'LH UH JHOPlLJHQQ %HVWDQGVEHUSUIXQJHQ GHUU $SRWKHNHQ DOV ZHLWHUH 3IOLFKWW GHVVPLWWHODOWHUOLFKHQQ0HGLFXVVVZHLVWWZHLWHUVVGDUDXIKLQQQGDVVVGLH$SRWKH NHQQVFKRQQGDPDOVVWDDWOLFKHUU.RQWUROOHXQWHUODJHQ
1DFKGLHVHP$XVIOXJLQGDV0LWWHODOWHUZRRGLHH:XU]HOQXQVHUHVPRGHUQHQQ *HVXQGKHLWVZHVHQVV ]X ILQGHQQ VLQG JLOW QXQ GDVV $XJHQPHUN GHU MQJHUHQ *HVFKLFKWH XQGG GHUU (QWZLFNOXQJJ ELVV ]XP KHXWLJHQQ 7DJH ,P =XJHH LKUHUU $UEHLWW ]XPP |VWHUUHLFKLVFKHQ *HVXQGKHLWVZHVHQQ DQDO\VLHUHQQ +RIPDUFKHU XQGG 5DFNN GLH KLVWRULVFKH (YROXWLRQ ZHOFKH QDFKIROJHQG LQQ WDEHOODULVFKHU
9JO+RIPDUFKHU5DFNNNN6666I
Arbeit zitieren:
Robert Andexer, 2004, Einsatz moderner Planungs- und Analysemodule zur Effizienzsteigerung und Kostenreduktion im Gesundheitswesen und speziell im OP-Bereich, München, GRIN Verlag GmbH
Dieser Text kann über folgende URL aufgerufen und zitiert werden:
Einbetten
DOI
Formatvorlage (Microsoft Word) für eine Diplomarbeit, Masterarbeit, Ha...
Für MS Word 2003 - Update 2010
Vorlagen, Muster, Formulare, Infobroschüren
Ausarbeitung, 25 Seiten
Formatvorlage (OpenOffice) für eine Diplomarbeit, Masterarbeit, Hausar...
Vorlagen, Muster, Formulare, Infobroschüren
Ausarbeitung, 35 Seiten
Formatvorlage / Vorlage zur Erstellung einer Diplomarbeit, Bachelorarb...
Vorlagen, Muster, Formulare, Infobroschüren
Ausarbeitung, 15 Seiten
Formatvorlage / Vorlage für eine Diplomarbeit / Hausarbeit
Für MS Word 2007 - dotx
Vorlagen, Muster, Formulare, Infobroschüren
Ausarbeitung, 25 Seiten
Anleitung zum Erstellen schriftlicher Arbeiten: Der Aufbau einer wisse...
Vorlagen, Muster, Formulare, Infobroschüren
Ausarbeitung, 20 Seiten
Erstellen einer schriftlichen Hausarbeit
Vorlagen, Muster, Formulare, Infobroschüren
Hausarbeit, 14 Seiten
Grundtechniken wissenschaftlichen Arbeitens
Bibliografieren - Reden - Schr...
Vorlagen, Muster, Formulare, Infobroschüren
Skript, 46 Seiten
Ratgeber zur Erstellung wissenschaftlicher Arbeiten. Diplomarbeiten - ...
Vorlagen, Muster, Formulare, Infobroschüren
Ausarbeitung, 39 Seiten
Informationswissenschaften, Informationsmanagement: Einsatz moderner Planungs- und Analysemodule zur Effizienzsteigerung und Kostenreduktion im Gesundheitswesen und speziell im OP-Bereich ist nun auf dem Buchmarkt erhältlich
Informationswissenschaften, Informationsmanagement: neuer Titel erschienen: Einsatz moderner Planungs- und Analysemodule zur Effizienzsteigerung und Kostenreduktion im Gesundheitswesen und speziell im OP-Bereich
Robert Andexer hat einen neuen Text hochgeladen
Geometric Modelling, Numerical Simulation, and Optimization
Applied Mathematics at SINTEF
Geir Hasle, Knut-Andreas Lie, Ewald Quak
Aktives Kreditrisikomanagement: Einsatz moderner Kreditrisikotransferi...
Chancen und Risiken unter Berü...
Sebastian Thamm
Der Einsatz moderner Informationstechnologien in der Automobilprodukte...
Produktivitätspotenziale und S...
Viktoria Heindorf
Applications of Simulation Methods in Environmental and Resource Econo...
Riccardo Scarpa, Anna Alberini
0 Kommentare