[Bearing of costs for in-patient treatment of sudden deafness: what the physician should know in the light of the actual jurisdiction].
In Germany, the in-patient treatment of sudden deafness is possible according to the indications given in the guide-lines of the Association of the Scientific Medical Societies. But public and private health insurances often reject bearing the costs later. Their arguments are that there is no rational justification for an in-patient treatment for lack of evidence and that any treatment could be done also on an out-patient basis. Hospitals sued these insurances and now judgments - particular of the Federal Supreme Court (FSC) - are published which strengthen the legitimacy of an in-patient treatment under certain circumstances. According to the law suits, the hospital doctor is mainly responsible for the indication of hospitalization. Also the FSC stressed that the chosen treatment in the hospital can not be questioned retrospectively by the insurance company as long as it is within good medical practise (see guide lines). The grade of evidence is not the decisive factor. The only institution, which can exclude treatments from being practiced in a hospital, according to the German Social Security Code, is the Federal Joint Committee Hospital. The treatment protocol itself must reveal the necessity of hospitalization (need for surveillance, side effects etc.).
Michel
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Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde. Universität zu Köln. 50924 Köln. Michel@uni-koeln.de
Wienke
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D003365:Costs and Cost Analysis; D005858:Germany; D003639:Hearing Loss, Sudden / Q000191:economics / Q000628:therapy*; D006801:Humans; D007297:Inpatients / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D010820:Physicians / Q000331:legislation & jurisprudence*; D012943:Social Security / Q000191:economics / Q000331:legislation & jurisprudence*