Financing of certified centers: a willingness-to-pay analysis.
BACKGROUND
Although care in certified breast centers is now established throughout Germany, numerous services are still not being reimbursed. This also affects other centers involved in the specialty of gynecology such as gynecological cancer centers, perinatal centers, and endometriosis centers. Although a certified center is entitled to charge additional fees, these are in most cases not reimbursed. Calculation of additional costs is limited by the fact that data from the Institute for the Hospital Reimbursement System (Institut für das Entgeltsystem im Krankenhaus, InEK) do not reflect interdisciplinary services and procedures. For decision-makers, society's willingness to pay is an important factor in guiding decisions on the basis of social priorities. A hypothetical maximum willingness to pay can be calculated using a willingness-to-pay analysis, making it possible to identify deficiencies in the arbitrary setting of health budgets at the macro-level.


METHODS
In a multicenter study conducted between November 2009 and December 2010, 2,469 patients at a university hospital and at a non-university hospital were asked about the extent of their awareness of certified centers, the influence of centers on hospital presentation, and about personal attitudes toward quality-oriented reimbursement. A subjective assessment of possible additional charges was calculated using a willingness-to-pay analysis.


RESULTS
In the overall group, 53.4 % of the patients were aware of what a certified center is and 27.4 % had specific information (obstetrics 40.0/32.3 %; mastology 66.8/23.2 %; gynecological oncology 54.7/27.3 %; P < 0.001). For 43.8 %, a certified center was one reason or the major reason for presentation (obstetrics 26.2 %; mastology 66.8 %; gynecological oncology 46.6 %; P < 0.001). A total of 72.6 % were in favor of quality-oriented reimbursement and 69.7 % were in favor of an additional charge for a certified center amounting to €538.56 (mastology €643.65, obstetrics €474.67, gynecological oncology €532.47). In all, 33.9 % would accept an increase in health-insurance fees (averaging 0.3865 %), and 28.3 % were in favor of reduced remuneration for non-certified centers.


CONCLUSIONS
The existence of certified centers is being increasingly recognized by patients. Additional charges for certified centers are generally supported. There is therefore a clear demand for them-from patients as well. This may be useful when negotiations are being conducted.
Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
Falk C
FC
Thiel
Anton
A
Scharl
Thomas
T
Hildebrandt
Efstratios
E
Kotziabassis
Michael G
MG
Schrauder
Mayada R
MR
Bani
Andreas
A
Müller
Tanja
T
Hauzenberger
Christian R
CR
Loehberg
Sebastian M
SM
Jud
Peter A
PA
Fasching
Arndt
A
Hartmann
Rüdiger
R
Schulz-Wendtland
Vratislav
V
Strnad
Matthias W
MW
Beckmann
Michael Patrick
MP
Lux
D001294:Attitude to Health; D002173:Cancer Care Facilities / Q000191:economics*; D002568:Certification / Q000191:economics; D005249:Fees and Charges; D005260:Female; D005858:Germany; D006176:Gynecology / Q000191:economics; D006771:Hospitals, Maternity / Q000191:economics*; D006801:Humans; D012051:Reimbursement Mechanisms / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics; D011795:Surveys and Questionnaires