[In Process Citation]

Since 1996 thoracic surgery has been invoiced according to fixed reimbursement rates (Sonderentgelte, SE). The legislator argues that fixed reimbursement rates cover operation costs and justify a 20% reduction in reimbursement for nursing. In order to examine this assumption we performed a cost analysis of thoracic surgery. Taking into account the staff, equipment, and operating theatre supplies, we analyzed 30 cases of five different types of operation prospectivly: wedge resections with more than three wedges (AR: n = 8), lobectomies (LE: n = 8), pneumonectomies (PE: n = 5), thoracoscopic wedge resections (VR: n = 6) and resections of mediastinal tumors (MR: n = 3). Then we calculated the overall costs for each operation. The costs for a LE amounted to DM 9,927, which is DM 4,904 more than the corresponding fixed reimbursement rate. The costs were DM 11,562 for a PE, DM 12,477 for a VR and DM 7,532 for a MR. Thus the costs were DM 5,539, DM 2,435 or DM 1,907 higher than the corresponding fixed reimbursement rates. The fixed reimbursement rate for an AR was DM 866 higher than the actual cost of DM 6,922. Only for a small number of cases do the fixed reimbursement rates cover the actual costs of thoracic surgery. Thus operation costs still need to be at least partly covered by the reimbursement for nursing.