title: Reimbursement for tissue reconstruction by pedicled and free flaps across five European countries. The importance of autologous breast reconstruction.
abstract: OBJECTIVE
  Case payment mechanisms have become the principle means of remunerating hospitals in many countries. We analysed the reimbursement for different types of autologous tissue transfer in five European countries.
  
  
  METHODS
  We looked at common surgical options for breast reconstruction and flaps at other body regions. The principle diagnosis was systematically modified and processed with national grouper software to identify the relevant Diagnosis-Related Groups.
  
  
  RESULTS
  The mean difference in payment was 4509 € in breast reconstruction versus only 2599 € in other locations. According to the underlying diagnosis for reconstruction, procedures after resection of malignant breast cancer showed higher reimbursement (mean 8319 €) than of other body parts (mean 6454 €). Sweden had the highest mean reimbursement (9589 €) followed by Austria (8032 €), Germany (7259 €), Italy (6667 €) and the UK (6037 €). Austria, Italy and the UK showed significant differences of reimbursement between pedicled flaps of the breast and other parts of the body.
  
  
  CONCLUSIONS
  International data for the benchmarking and refinement of a national compensation system can be a useful instrument in identifying ways of improving each system. Across a spectrum of European countries, reimbursement for the reconstruction of the breast and other body parts was analysed and characteristics were identified. As rationalisation of healthcare becomes widespread in European countries, the need for individualised reimbursement which correlates accordingly is becoming ever more important.
authors.affiliation: Clinic for Plastic, Hand and Reconstructive Surgery, Eberhard-Karls University, Tuebingen, Germany. oliver.lotter@freenet.de
authors.forename: O
authors.initials: O
authors.lastname: Lotter
authors.forename: S
authors.initials: S
authors.lastname: Stahl
authors.forename: W A
authors.initials: WA
authors.lastname: Townley
authors.forename: S
authors.initials: S
authors.lastname: Hoefert
authors.forename: H
authors.initials: H
authors.lastname: Eberhard Schaller
authors.forename: A
authors.initials: A
authors.lastname: Amr
mesh_terms: D001132:Arm / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery; D002056:Burns / Q000601:surgery; D002081:Buttocks / Q000601:surgery; D003953:Diagnosis-Related Groups; D005060:Europe; D005260:Female; D006257:Head / Q000601:surgery; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D007866:Leg / Q000601:surgery; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D009369:Neoplasms / Q000601:surgery; D009928:Organ Specificity; D012051:Reimbursement Mechanisms; D013524:Surgical Flaps / Q000191:economics*; D060726:Torso / Q000601:surgery