[Economic aspects of sleep medicine]

According to its rules it is the task of the German Sleep Research Society (DGSM) to promote scientific research in the area of Sleep Medicine in Germany and to transform scientific results into clinical practice for the benefit of patient care. The international classification of sleep disorders (ICSD) distinguishes more than 80 different disorders which can be treated due to scientific progress which has been made over the last 50 years. The conversion of established scientific knowledge in the field of sleep medicine into an improved clinical management of patients should not be prevented by the lack of sufficiently equipped sleep units. The federal government has stated that, due to financial constraints, it would not consent to any measures which might lead to a budget increase, such as case oriented special payments for certain diseases. Thus, an adequate number of sleep units can only be provided by integrating these units into the budget of the respective hospitals and departments, paid by the local insurance companies, thus providing the necessary financial resources to the sleep units. Many services in the area of sleep medicine can be covered by the existing reimbursement system. In some cases, however, a definite diagnosis can only be made by the use of complete polysomnography (PSG). For a complete PSG the additional costs have been calculated by the DGSM to be 1195,-DM per 24 h. Sleep units dealing with both diagnostically and therapeutically complex cases such as patients requiring complex forms of nasal ventilation, depend on an increase in the reimbursement by the insurance companies to cover the expenses involved. For each sleep unit, a "case-mix" can be calculated which will include both complex and less complex cases. The costs using this case mix will be considerably lower than the cost for a complete PSG. Sleep units provide the basis for education and quality assessment which are necessary for competent patient management in the future. Adequate diagnostic and therapeutic facilities in sleep medicine provide the basis for patient care, contribute to improved health standards and, thus, reduce social costs of these frequent diseases.