Sinzobahamvya Nicodème, Kopp Thorsten, Arenz Claudia, Blaschczok Hedwig C, Hraska Viktor, Asfour Boulos
1 Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany.
2 Control Department, Asklepios Clinic, Sankt Augustin, Control Department, Asklepios Clinic, Germany.
Cardiol Young. 2014 Apr;24(2):344-50. doi: 10.1017/S1047951113000437. Epub 2013 May 13.
A total of 458 hospital stays during the year 2011 were analysed to determine whether reimbursement by the current German Diagnosis-Related Groups system covers the costs incurred during hospital stay for congenital heart surgery. The costs of every hospital stay were estimated according to the guidelines of the Institute for the Hospital Remuneration System, an institute responsible for encoding hospital reimbursement in Germany. Cost-weight values of the year 2012 were applied for reimbursement. Related additional compensations were also included. Hospital costs ranged from 8896.26 to 193,671.94 euros per case, with a mean of 30,597 and standard deviation of 25,032 euros. Reimbursement varied from 8630.35 to 173,710.65 euros, with a mean of 25,514 and standard deviation of 18,497 euros: an underfunding of 17%. Fifty-nine per cent (271/458) of cases were classified, according to Aristotle complexity score, in higher comprehensive complexity: Levels 4-6. Costs highly correlated with complexity levels (Spearman's r coefficient = 0.89) and the regression was linear. Underfunding increased, linearly, from 6% for procedures with Level 1, lowest comprehensive complexity, to 23% for those with Level 6, highest complexity. In conclusion, this study demonstrates that reimbursement by the current German Diagnosis-Related Groups system increasingly penalises complex congenital heart surgery. Aristotle complexity score could help to correct this prejudicial situation.
对2011年期间的458次住院情况进行了分析，以确定德国现行诊断相关分组系统的报销费用是否涵盖先天性心脏手术住院期间产生的费用。每次住院的费用均根据医院薪酬系统研究所的指导方针进行估算，该研究所负责对德国的医院报销进行编码。报销采用2012年的成本权重值。还包括相关的额外补偿。每个病例的住院费用从8896.26欧元到193,671.94欧元不等，平均为30,597欧元，标准差为25,032欧元。报销金额从8630.35欧元到173,710.65欧元不等，平均为25,514欧元，标准差为18,497欧元：资金缺口为17%。根据亚里士多德复杂性评分，59%（271/458）的病例被归类为更高的综合复杂性：4 - 6级。成本与复杂性水平高度相关（斯皮尔曼r系数 = 0.89），且回归呈线性。资金缺口呈线性增加，从综合复杂性最低的1级手术的6%增加到综合复杂性最高的6级手术的23%。总之，本研究表明，德国现行诊断相关分组系统的报销越来越不利于复杂的先天性心脏手术。亚里士多德复杂性评分有助于纠正这种不公平的情况。
