Resource usage in outpatient care and reimbursement for cystic fibrosis in Germany

Abstract

International audienceObjective Objective of this study is to assess and evaluate resource use in outpatient treatment in Germany and to compare it with remuneration. Methods Outpatient treatment was evaluated in seven different centers for pediatric and adult CF patients. Data was recorded during one representative month in 2006. A micro-costing approach was used to value resource use data. Results For outpatient treatment mean costs (excluding drugs) of 488 € per patient per quarter occurred. Correlation analysis identified significant cost drivers including age and co-morbidities (pancreatic insufficiency, hepatobiliary complications, lung function capacity or bacterial lung colonization). Remuneration covered only 51% of the total costs (252 € per patient/quarter). Conclusions As the human resources available to these centres today are already below the requirements set by the European consensus for standards of CF care it will be important for of a high level of patient care to reach a cost-covering remuneration scheme

Staff costs of hospital-based outpatient care of patients with cystic fibrosis

“…The cost analysis of six studies was based on individual resource use under routine care [ 8 , 10 , 13 , 14 , 21 , 22 ], while two calculated annual costs from the aggregate perspective [ 17 , 18 ]. Only two studies examined different cost categories for outpatient treatment allowing the estimation of costs for health personnel [ 22 , 23 ]. Comparison of our findings with those of other studies addressing CF outpatient costs is not straightforward as the methodology used, perspective adopted, and health service utilization and organization vary.…”

“…Eidt-Koch assessed the total resource use for CF outpatient care including costs for personnel, laboratory examinations, medication, overhead and infrastructure [ 23 ]. In addition, this study compared the evaluated costs with the actual reimbursement according to the official German Remuneration Scheme for Outpatient Care (EBM) and showed that about half of the costs are left to the CF centres suggesting that "alternative reimbursement schemes should be thought of" [ 23 ]. Specifically, Eidt-Koch's study explored determinants of costs by dividing 326 patients in seven CF centres in Germany according to their age, FEV1 values, certain co-morbidities, and bacterial lung colonization.…”

“…These activities, carried out by physicians, include the organization and documentation of outpatient and home-based care, quality assurance measures, interdisciplinary coordination and continuous CF-specific medical education. Given that in Germany only about 50% of the actual costs for hospital-based outpatient service utilization are reimbursed [ 10 , 23 ], these additional activities without patient contact have to be considered for a cost-covering remuneration.…”

“…The unit costs that we used in our study are based on the gross labour costs ("Arbeitgeberbrutto") of all personnel employed within a specific wage group according to the German public service salary scheme ("BAT"), which encompasses social security and pension contributions as well as sick and annual leave. We used the average gross labour costs for each occupational category as identified by the study of Eidt-Koch in a representative university hospital [ 23 ].…”

“…Moreover, most studies calculating the costs of CF are based on a gross-costing approach. Only two studies used a micro-costing approach in calculating costs of hospital and outpatient care, respectively [ 15 , 23 ]. Such information is important for understanding the true costs of all components of CF treatment and underlying reasons for variation in costs.…”