title: Cochlear implantation in different health-care systems:  disparities between Germany and the United States.
abstract: BACKGROUND
  Cochlear implantation is a popular procedure to restore hearing in patients with severe-to-profound hearing loss. Despite the widespread acceptance of the intervention, many variables exist in the evaluation for and implementation of this technology throughout the world. The primary aim of this investigation is to analyze treatment disparities between Germany and the United States in cochlear implantation.
  
  
  METHODS
  Cochlear implant recipients in 2 representative cochlear implant centers in the United States and Germany were retrospectively analyzed. Differences in preoperative, perioperative, and postoperative treatment paradigms as well as the disparities in the follow-up were recorded. Objective measures included demographic data, length of hospitalization, minor and major complication rates, and speech scores within the first 3 years. Moreover, a cost analysis comparison between both centers was performed.
  
  
  RESULTS
  A number of differences in treatment were noted between the two centers. The primary difference was that in Germany the procedure was inpatient with an average 4-day hospital stay, whereas in the United States, it was an outpatient procedure. Despite these differences, only small differences were noted in the category of minor complications, and no differences were seen in the category of major complications between the 2 centers. Comparing the results of monosyllabic speech tests, no major differences could be detected. Cost analysis between the 2 centers demonstrates that, whereas in Germany, all charges are covered by the statutory health insurance, in the United States, the reimbursements are significantly lower than the charges.
  
  
  CONCLUSIONS
  Despite differences in the clinical approach to cochlear implants in Germany versus the United States, no significant differences in outcomes were seen in the 2 groups, and the complication rates were nearly identical. Interestingly, although the procedure in Germany is associated with a 4-day hospital stay, the charges for the entire procedure in Germany are approximately ½ as compared with those in the United States, although the actual reimbursement for this procedure may be lower in the United States than in Germany.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany. teschner@phy.ucsf.edu
authors.forename: Magnus
authors.initials: M
authors.lastname: Teschner
authors.forename: Colleen
authors.initials: C
authors.lastname: Polite
authors.forename: Thomas
authors.initials: T
authors.lastname: Lenarz
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lustig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003054:Cochlear Implants / Q000009:adverse effects / Q000191:economics*; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D054625:Healthcare Disparities; D006319:Hearing Loss, Sensorineural / Q000191:economics / Q000601:surgery*; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States