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[Comparison of hand surgery in the German and Italian DRG systems]
O Lotter1, J Dolderer, S Stahl
1Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik/Eberhard-Karls-Universität Tübingen, Tübingen. oliver.lotter@freenet.de
Insights
The German Diagnosis-Related Groups (DRG) system offers higher reimbursement for hand surgery cases compared to Italy. Adjusting for purchasing power narrows the financial gap between the two DRG systems.
Area of Science:
- Health Economics
- Medical Coding Systems
- Surgical Outcomes Analysis
Background:
- Diagnosis-Related Groups (DRGs) classify patients based on resource consumption.
- Comparing international DRG systems is crucial for understanding healthcare economics and reimbursement variations.
Purpose of the Study:
- To compare the Italian and German DRG systems for hand surgery, focusing on clinical case reimbursement.
- To analyze differences in length of stay and financial compensation between the two systems.
Main Methods:
- Utilized DRG grouper for 15 common hand surgical diagnoses and treatments.
- Transferred data to the Italian system for comparative analysis of length of stay and reimbursement.
- Adjusted reimbursement figures by country-specific purchasing power parity.
Main Results:
- Germany's DRG system showed higher reimbursement for 15 out of 19 analyzed cases.
- The mean Case Mix Index (CMI) in Germany (0.917) resulted in higher per-case payments (€2,676) than Italy's hypothetical CMI (0.635, €1,853).
- Finger replantation reimbursement was significantly higher in Germany, with a difference of €12,320 per service.
Conclusions:
- The German DRG system provides more favorable reimbursement for hand surgery compared to the Italian system.
- Resource consumption for procedures like finger replantation appears inadequately represented in the Italian DRG system.
- Purchasing power parity significantly reduces, but does not eliminate, the observed reimbursement discrepancies between Germany and Italy.
Abstract:
Diagnosis-related groups (DRGs) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis we compared the Italian and the German DRG systems regarding hand surgery with an emphasis on reimbursement of clinical cases. The 15 most common hand surgical diagnoses and their corresponding operative treatment in our clinic in 2009 were processed using a DRG grouper. The underlying data were transferred to the Italian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The latter was adjusted and corrected by the purchasing power of each country. The mean of the upper threshold of length of stay was 10 days in the German as well as the Italian system whereas the median was 2 times higher in Italy (6 vs. 12 days). Fifteen out of 19 cases showed higher reimbursement in Germany. The case mix index (CMI) of 0.917 in Germany represents a mean payment of 2,676 € per case. In Italy the hypothetical CMI of 0.635 resulted in a mean reimbursement of 1,853 € per case. The biggest difference in remuneration could be found for replantation of multiple fingers. For this service the German health-care system pays 12,320 € more than the Italian. Total proceeds of the top 15 diagnoses applying the number of cases treated in our clinic revealed 1.7 million € in the German and 1.2 million € in the Italian DRG system. Considering the purchasing power utilizing consumer prize parities, the difference of reimbursement between the countries decreased to 300,000 €. There is no mean length of stay per DRG in Italy, only the upper threshold of length of stay is determined. In most cases the latter is higher in Italy compared to Germany. The consumption of resources for finger replantation is not adequately represented in the Italian DRG system compared to finger amputation. Reimbursement of inpatient care is influenced by multiple factors not being subject to the free market economy. For this reason only descriptive comparison is feasible.
