[Analysis of costs and profits of ambulatory care of Marfan patients after initiation of a novel German legal directive (116 b SGB V)].
BACKGROUND
The Marfan syndrome is a typical rare disease with multiorgan involvement and the need for specialized interdisciplinary medical care. A novel German legal directive according to section sign 116 b of the Social Statutes Book V (116 b SGB V) improves options for reimbursement and thus encourages specialized hospitals to provide ambulatory care for rare diseases such as Marfan syndrome. The authors provide the first economic analysis of section sign 116 b in a German Marfan center.


METHODS
The costs were assessed in 184 cases with Marfan syndrome receiving medical care in the Hamburg Marfan Clinic. The authors assessed the financial profit both according to payments received from invoices established according to the 116 b directive [reimbursement (116b)] and from calculations according to section sign 117 SGB V [reimbursement (117)].


RESULTS
A total of 117 patients traveled to the Marfan clinic (64%) < 50 km, 27 patients (15%) between >or= 50 and <or= 100 km, and 40 patients (22%) > 100 km. The total costs for ambulatory care were 71,606.28 Euro. The reimbursement (116b) was 55,549.87 Euro and the reimbursement (117) was 11,776.00 Euro.


CONCLUSIONS
Many patients accept long distances of traveling to receive specialized ambulatory medical care. However, for optimal patient management specialized centers need to cooperate intensively with local health care providers. The novel legal directive according to section sign 116 b has significantly improved reimbursement for Marfan centers and allows for improving the quality of medical care.
Manow
Marie-Luise
ML
Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
Paulsen
Nesrin
N
Rybczynski
Meike
M
Mir
Thomas
T
Bernhardt
Alexander M J
AM
Treede
Hendrik
H
Ohm
Gunda
G
Fuisting
Bettina
B
Rehder
Uwe
U
Meier
Florian
F
Vogler
Marina
M
Meinertz
Thomas
T
Overlack
Karin
K
von Kodolitsch
Yskert
Y
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000331:legislation & jurisprudence*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000331:legislation & jurisprudence*; D005102:Health Expenditures / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D006782:Hospitals, Special / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D008382:Marfan Syndrome / Q000191:economics* / Q000628:therapy*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence*; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000331:legislation & jurisprudence; D010348:Patient Care Team / Q000191:economics / Q000331:legislation & jurisprudence; D035583:Rare Diseases; D012017:Referral and Consultation; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000331:legislation & jurisprudence*; D055815:Young Adult
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