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[In Process Citation]

Lang1, Kolb, Liewald

  • 1Klinik und Poliklinik fur Thorax- und Gefasschirurgie, Universitat Ulm.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|March 9, 1999
PubMed
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Fixed reimbursement rates for thoracic surgery often fail to cover actual operational costs. This analysis reveals that nursing reimbursement is crucial for covering deficits in procedures like lobectomies and pneumonectomies.

Area of Science:

  • Thoracic Surgery
  • Health Economics
  • Surgical Cost Analysis

Background:

  • Since 1996, thoracic surgery in Germany has been reimbursed via fixed rates (Sonderentgelte, SE).
  • Legislators assume these rates cover operational costs, justifying a 20% reduction in nursing reimbursement.
  • This study investigates the validity of this assumption through a detailed cost analysis.

Purpose of the Study:

  • To conduct a prospective cost analysis of various thoracic surgery procedures.
  • To compare the actual costs of these operations with the established fixed reimbursement rates.
  • To determine if current reimbursement adequately covers surgical expenses and impacts nursing care funding.

Main Methods:

  • Prospective analysis of 30 thoracic surgery cases across five procedure types: wedge resections (AR), lobectomies (LE), pneumonectomies (PE), thoracoscopic wedge resections (VR), and mediastinal tumor resections (MR).

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  • Inclusion of costs for staff, equipment, and operating theatre supplies.
  • Calculation of overall costs per operation and comparison with fixed reimbursement rates.

    • Main Results:

    • Lobectomies (LE) cost DM 9,927, exceeding reimbursement by DM 4,904.
    • Pneumonectomies (PE) cost DM 11,562, VR cost DM 12,477, and MR cost DM 7,532, with deficits of DM 5,539, DM 2,435, and DM 1,907, respectively.
    • Wedge resections (AR) were the only procedure type where fixed reimbursement (DM 6,922) exceeded actual costs by DM 866.

    Conclusions:

    • Fixed reimbursement rates for most thoracic surgeries do not cover actual operational costs.
    • A significant deficit exists for complex procedures like lobectomies and pneumonectomies.
    • Nursing reimbursement remains essential for covering the financial shortfalls in thoracic surgery operations.