title: Financial viability of perinatal centers in the longer term, taking legislative requirements into account. An examination of the cost-revenue structure of a Level I perinatal center.
abstract: BACKGROUND
  Debate is currently taking place over minimum case numbers for the care of premature infants and neonates in Germany. As a result of the Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA) guidelines for the quality of structures, processes, and results, requiring high levels of staffing resources, Level I perinatal centers are increasingly becoming the focus for health-economics questions, specifically, debating whether Level I structures are financially viable.
  
  
  METHODS
  Using a multistep contribution margin analysis, the operating results for the Obstetrics Section at the University Perinatal Center of Franconia (Universitäts-Perinatalzentrum Franken) were calculated for the year 2009. Costs arising per diagnosis-related group (DRG) (separated into variable costs and fixed costs) and the corresponding revenue generated were compared for 4,194 in-patients and neonates, as well as for 3,126 patients in the outpatient ultrasound and pregnancy clinics.
  
  
  RESULTS
  With a positive operating result of € 374,874.81, a Level I perinatal center on the whole initially appears to be financially viable, from the obstetrics point of view (excluding neonatology), with a high bed occupancy rate and a profitable case mix. By contrast, the costs of prenatal diagnostics, with a negative contribution margin II of € 50,313, cannot be covered. A total of 79.4% of DRG case numbers were distributed to five DRGs, all of which were associated with pregnancies and neonates with the lowest risk profiles.
  
  
  CONCLUSIONS
  A Level I perinatal center is currently capable of covering its costs. However, the cost-revenue ratio is fragile due to the high requirements for staffing resources and numerous economic, social, and regional influencing factors.
authors.affiliation: Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21-23, 91054 Erlangen, Germany. michael.lux@uk-erlangen.de.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.forename: Florian
authors.initials: F
authors.lastname: Kraml
authors.forename: Stefanie
authors.initials: S
authors.lastname: Wagner
authors.forename: Carolin C
authors.initials: CC
authors.lastname: Hack
authors.forename: Christine
authors.initials: C
authors.lastname: Schulze
authors.forename: Florian
authors.initials: F
authors.lastname: Faschingbauer
authors.forename: Mathias
authors.initials: M
authors.lastname: Winkler
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Hildebrandt
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005380:Financing, Government; D005858:Germany; D006801:Humans; D008430:Maternal-Child Health Centers / Q000191:economics* / Q000331:legislation & jurisprudence; D008503:Medical Staff / Q000191:economics; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence; D018743:Perinatal Care / Q000191:economics* / Q000331:legislation & jurisprudence; D011247:Pregnancy; D012456:Salaries and Fringe Benefits / Q000191:economics
keywords: DRG; Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA); Perinatal centers; contribution margin analysis; financing; staffing resources