[Costs of ambulatory care for RA patients in Germany].
BACKGROUND
In 2000, the Regional Cooperative Center for Rheumatic Conditions in Hannover, Germany, initiated a project to introduce and evaluate a case-based clinical quality management system to enhance the quality of care for patients with rheumatoid arthritis. Building on that, it was possible to combine all resource uses, as paid by the sickness funds, including those in ambulatory care.


METHODS
The purpose of this study was to reach average "per-visit prices" for single physician visits, not only for rheumatologists, but also for other specialists as well as generalists. Those visits all had to be connected to the rheumatic condition of the patients. All ambulatory care visits for 1 year (2001) were evaluated.


RESULTS
Due to the high number of physician visits of the 338 patients with clinically assured rheumatoid arthritis included in the study (rheumatologist visits 4,488, generalist visits 3,901), statistically significant subgroups could be built. The average costs per visit associated with rheumatoid arthritis are: rheumatologist euro 22.71; generalist euro 8.02; as well as other specialties ranging from euro 5.81 to euro 19.48. The low price for generalists care is due to the selection of the cohort, as all patients are under constant specialist care. The prices were further broken down to certain subgroups of care.


CONCLUSIONS
The prices are calculated under the premises that no budgetary constraints apply to ambulatory care. This is not the reality in Germany. Hence, looking at the average frequency of rheumatologist visits in this cohort (13.2/year), the conclusion has to be that not all rheumatologic ambulatory care is being covered by the reimbursement system within the Statutory Health Insurance in Germany.
Mittendorf
Thomas
T
Forschungsstelle für Gesundheitsökonomie und Gesundheitssystemforschung, Universität, Hannover. tm@ivbl.uni-hannover.de
Merkesdal
Sonja
S
Zeidler
Henning
H
Graf von der Schulenburg
J-Matthias
JM
Ruof
Jörg
J
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D001172:Arthritis, Rheumatoid / Q000191:economics*; D016022:Case-Control Studies; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005251:Fees, Medical / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*