Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries.

This paper assesses variations in the cost of primary hip replacement between and within nine member states of the European Union (EU). It also compares the cost of service with public-payer reimbursements. To do so, data on cost and reimbursement were surveyed at the micro-level in 42 hospitals in Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland, and Spain. The total cost of treatment ranged from 1290 euros (Hungary) to 8739 euros (The Netherlands), with a mean cost of 5043 euros (STD +/- 2071 euros). The main cost drivers were found to be implants (34% of total cost on average) and ward costs (20.9% of total cost on average). A one-way random effects analysis of variance model indicated that 74.0% of variation was between and only 26% of variation was within countries. In a two-level random-intercept regression model, purchasing-power parities explained 79.4% of the explainable between-country variation, while the percentage of uncemented implants used and the number of beds explained 12.1 and 1.6% of explainable within-country variation, respectively. The large differences in cost and reimbursement between Poland, Hungary, and the other EU member states shows that primary total hip replacement is a highly relevant case for cross-border care.