Rathmayer Markus, Heinlein Wolfgang, Reiß Claudia, Albert Jörg G, Akoglu Bora, Braun Martin, Brechmann Thorsten, Gölder Stefan K, Lankisch Tim, Messmann Helmut, Schneider Arne, Wagner Martin, Dollhopf Markus, Gundling Felix, Röhling Michael, Haag Cornelie, Dohle Ines, Werner Sven, Lammert Frank, Fleßa Steffen, Wilke Michael H, Schepp Wolfgang, Lerch Markus M
inspiring-health GmbH, München.
Abteilung Innere Medizin I mit Schwerpunkt Gastroenterologie, Robert-Bosch-Krankenhaus, Stuttgart.
Z Gastroenterol. 2017 Oct;55(10):1038-1051. doi: 10.1055/s-0043-118350. Epub 2017 Sep 8.
In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses.
在德国医院报销系统（G-DRG）中，内镜手术列在成本中心8。在医院科室与外部供应商之间的报销方面，仍在使用过时或不完整的目录（如DKG-NT、GOÄ）。我们评估了G-DRG系统中内镜手术的成本。为评估内镜手术成本，向医院薪酬系统研究所（InEK）每年提供成本数据的74家医院，以匿名形式（4873809个病例数据集）将其数据（2011 - 2015年；《医院报销法》第21条）提供给德国胃肠病学会（DGVS）。使用仅进行了一次内镜手术的病例（n = 274186），计算了46个内镜手术层级在5年期间的平均成本。可靠的平均内镜检查成本范围从胃镜检查的230.56欧元（144666例）、简单结肠镜检查的276.23欧元（n = 32294），到乳头切开术和塑料支架置入的内镜逆行胰胆管造影（ERCP）的844.07欧元（n = 10150）以及自膨式金属支架的ERCP的1602.37欧元（n = 967）。大学医院的成本更高，特别是对于复杂手术。基于来自74家InEK计算医院的《医院报销法》第21条数据集，这个内镜手术层级目录首次使得对德国医院内镜检查成本进行实际评估成为可能。大学医院成本较高可能是由于复杂病例和紧急干预的转诊偏倚。对于46个内镜手术层级，现在在G-DRG系统内进行客观的成本分配成为可能。通过国际比较，德国内镜手术的成本较低，这可能是由于更高的效率、更低的人员配置或实际费用记录不完整。
