[德国实施诊断相关分组后住院肿瘤护理的趋同趋势]

[Convergence tendencies in inpatient oncological care after implementation of diagnosis-related groups in Germany].

作者信息

Lüngen M, Rath T, Schwartze D, Büscher G, Bokern E

机构信息

Institut für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln, Köln.

出版信息

Gesundheitswesen. 2009 Dec;71(12):809-15. doi: 10.1055/s-0029-1215569. Epub 2009 May 19.

DOI:10.1055/s-0029-1215569

PMID:19455490

Abstract

BACKGROUND

An increase of the convergence of medical services towards specialised hospitals with high case numbers is often assumed as a result of the implementation of diagnosis-related groups (DRG; case-based lump sum reimbursement). So far, estimates of the extent to which this effect occurs after the recent implementation of DRGs are not available in Germany.

METHOD

Claims data of about 23,600,000 insured within the inclusive period 2004-2007 were analysed. All cases with the main diagnosis of lung cancer, prostate cancer, and colorectal cancer were included in the study. Broken down by entities and years, graphical and statistical concentration measures as well as the percentages of different hospital size classes were calculated.

RESULTS

Increasing case numbers could be observed for all entities within the period (lung cancer:+25.7%; prostate cancer:+12.5%; colorectal cancer:+8.1%). The concentration measures showed hardly any changes in the course of time. The absolute increase of case numbers seems to affect those hospitals with case numbers higher than 50 per year above average [lung cancer cases in a hospital group including hospitals with more than 50 cases 2004 (percentage): 78.1% and 2007: 81.6%; prostate cancer: 67.4% and 71.7%; colorectal: 72.5% and 75.9%], whereas case numbers of hospital groups including hospitals with case numbers less than 50 per year remain unchanged or grow more slowly.

DISCUSSION

The convergence of oncological services towards a few specialised centres has not yet been accelerated by the implementation of DRG's. Fundamentally, relative changes can be noticed due to case number increases in large centres, not because of service cutbacks and shifts from smaller hospitals. Reasons for this could either be the inflexibility of capacity planning or control options of the statutory health insurance.

CONCLUSION

Further research of convergence tendencies and its drivers is required to be able to draw any benefit from efficiency and quality potentials.

摘要

背景

由于实施了诊断相关分组（DRG；按病例支付总额报销），人们常常认为医疗服务会越来越多地集中于病例数量多的专科医院。到目前为止，德国尚无关于近期实施DRG后这种影响程度的估计。

方法

分析了2004 - 2007年期间约2360万参保人的理赔数据。研究纳入了所有主要诊断为肺癌、前列腺癌和结直肠癌的病例。按病种和年份进行细分，计算了图形和统计集中度指标以及不同规模医院类别的百分比。

结果

在此期间，所有病种的病例数均有增加（肺癌：+25.7%；前列腺癌：+12.5%；结直肠癌：+8.1%）。集中度指标在一段时间内几乎没有变化。病例数的绝对增加似乎影响了那些每年病例数高于平均水平50例的医院[在一个医院组中，肺癌病例数：2004年（百分比）78.1%，2007年81.6%；前列腺癌：67.4%和71.7%；结直肠癌：72.5%和75.9%]，而每年病例数少于50例的医院组的病例数保持不变或增长较慢。