title: A European comparison of reimbursement in breast reconstruction.
abstract: OBJECTIVE
  Case payment mechanisms have become the principal means of remunerating hospitals in most developed countries. The purpose of this study was to make an international comparison of reimbursement for breast reconstructive surgery.
  
  
  METHODS
  We analysed remuneration for unilateral and bilateral female breast reconstruction (pedicled flaps, free flaps, alloplastic procedures) across five different European countries. National grouper software was used to identify Diagnosis Related Groups from which the proceeds were derived.
  
  
  RESULTS
  The mean reimbursement was € 5593 for pedicled flaps, € 9149 for free flaps and € 4037 for implant-based reconstructions. The highest payments were in Sweden and the lowest in Italy. When adjusting payments by purchasing power parities, the relation among the countries did not change. The Austrian system makes a clear distinction between one-stage and two-stage delayed reconstructive interventions whereas reimbursement in other countries favoured a two-stage approach. Only one of five national reimbursement systems distinguishes between unilateral and bilateral reconstructions.
  
  
  CONCLUSIONS
  Across a spectrum of European countries, reimbursement for breast reconstruction was based on similar procedure-specific systems, although there was a wide variation in tariffs and consideration of other factors such as underlying diagnosis. As delivery of healthcare becomes more rationalised, there is a need for individualised reimbursement which correlates directly with activity. Drawing on the experience of different healthcare systems may lead to development of a more robust and fair system of reimbursement.
authors: Clinic for Plastic, Hand and Reconstructive Surgery, Burn and Trauma Center, Eberhard-Karls-University, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany. oliver.lotter@freenet.de
authors: O
authors: O
authors: Lotter
authors: S
authors: S
authors: Stahl
authors: J L
authors: JL
authors: Schiefer
authors: W A
authors: WA
authors: Townley
authors: H-E
authors: HE
authors: Schaller
authors: P
authors: P
authors: Jaminet
mesh_terms: D062088:Acellular Dermis / Q000191:economics; D000328:Adult; D000368:Aged; D001317:Austria; D001941:Breast Diseases / Q000191:economics / Q000601:surgery; D019928:Breast Implantation / Q000191:economics; D001943:Breast Neoplasms / Q000191:economics / Q000601:surgery; D003953:Diagnosis-Related Groups; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D005858:Germany; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000706:statistics & numerical data; D013524:Surgical Flaps; D013548:Sweden; D006113:United Kingdom