Zaage J, Pilz F, Lippert V, Peterson K
Klinik für Allgemeinchirurgie, Berufsgenossenschaftliche Kliniken, Stadt Halle-Bergmannstrost.
Zentralbl Chir. 1998;123 Suppl 4:104-7.
The introduction of flat charges per case and special fees, first put into effect on Jan. 1, 1996, has lead medical and administrative personnel to rethink how fixed daily hospital rates, costs individually determined by each hospital, and prime costs for hospital and nursing charges will be reimbursed. The amount paid for flat charge cases and special fees (in German Marks) are currently the same nationwide. This applicable system of billing consists of a combination of diagnosis (ICD 9) and the type of therapy administered after each specific operation (ICPM). Between Jan. 1, 1996 and Dec. 31, 1996 we had 78 cases, where detailed personnel and relevant costs were recorded with the aid of three sheets of medical records and two reports for each patient. When comparing expenditures and compensation, there were deficits in 75 cases and surpluses in 3. This existing pressure to cut costs should not be allowed to lead to uncritical medical judgement. The major costs of an operation are for disposable materials, especially for the use of the endo-cutter. Laparoscopic appendectomies, on selected patients in our clinic, has created a deficit when covering costs for open appendectomies. The knowledge we have gained from this now enables us to balance out the deficit.
自1996年1月1日起实施的按病例收取固定费用和特殊费用的做法，促使医疗和行政人员重新思考如何报销医院每日固定费用、各医院单独确定的成本以及医院和护理费用的主要成本。目前，全国范围内按固定费用病例和特殊费用支付的金额（以德国马克计）是相同的。这种适用的计费系统由诊断（ICD 9）和每次特定手术后所采用的治疗类型（ICPM）组合而成。在1996年1月1日至1996年12月31日期间，我们有78个病例，借助三份病历表和每位患者的两份报告记录了详细的人员和相关成本。在比较支出和补偿时，有75个病例出现亏损，3个病例出现盈余。不应让现有的削减成本压力导致不加批判的医疗判断。手术的主要成本在于一次性材料，尤其是内切割器的使用。在我们诊所，对部分患者进行腹腔镜阑尾切除术时，在支付开腹阑尾切除术的成本方面出现了亏损。我们现在从中学到的知识使我们能够弥补这一亏损。
