Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting.
BACKGROUND
German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology.


METHODS
A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003-06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail.


RESULTS
It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed.


CONCLUSIONS
The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.
Hensen
P
P
Department of Dermatology, Medical Management, University of Münster, D-48149 Münster, Germany. hensenp@mednet.uni-muenster.de
Beissert
S
S
Bruckner-Tuderman
L
L
Luger
T A
TA
Roeder
N
N
Müller
M L
ML
D003880:Dermatology / Q000191:economics* / Q000379:methods; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006291:Health Policy / Q000191:economics / Q000639:trends; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007297:Inpatients; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007902:Length of Stay; D020379:Risk Adjustment; D012871:Skin Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy*