[Inadequate reimbursement for surgical patients with Parkinson's disease according to diagnosis-related grouping].
BACKGROUND
Parkinson's disease (PD) is a progressive degenerative disease of the human central nervous system with a demographical increase in surgical patients. Comorbidities are known to increase the perioperative risk profile and therefore amplify treatment expenses.


OBJECTIVE
The aim of this study was to analyse whether the reimbursement of additional costs due to PD in surgical patients was sufficiently considered by diagnosis-related grouping (DRG).


METHODS
Over a period of 13 years, 50 patients suffering from MP treated in the Department of Surgery were retrospectively compared using matched-pair analysis with controls not affected by PD. Both groups of patients were assessed regarding hospital stay and mortality and morbidity with an emphasis on reimbursement by the National Ordinance on Hospital Rates (Bundespflegesatzverordung, BPflV) from 2004 (last year of employment) compared to DRG in 2007.


RESULTS
Extra reimbursement for PD patients in comparison to controls diminished from 20 % according to BPflV (2004) to 2 % according to DRG (2007). Within the DRG System of 2007, total compensation for PD and control patients was significantly lower (47 vs. 35 %) compared to the BPflV of 2004.


CONCLUSIONS
Compensation of surgical therapy in PD patients has significantly decreased within the DRG system, not considering the increased perioperative risk profile of these patients. In times of rising economic pressure, inadequate reimbursement of treatment costs bears the risk of rejection or restriction for patients with concomitant PD in spite of medical indications.
Müller
M
M
Universitätsklinikum Bonn, Klinik für Orthopädie und Unfallchirurgie, Bonn, Deutschland.
Hemicker
G
G
Jüptner
U
U
Wuellner
U
U
Wirtz
D C
DC
Hirner
A
A
Standop
J
J
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000191:economics*; D005245:Fee Schedules / Q000191:economics*; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D010300:Parkinson Disease / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D011157:Population Dynamics; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000628:therapy; D012051:Reimbursement Mechanisms / Q000191:economics*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000191:economics*; D016019:Survival Analysis