title: [Incentives of German Rehabilitation Centers to Implement Screening Strategies for the Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) Transmissions and Infections].
abstract: OBJECTIVE
  The colonization with Methicillin-resistant Staphylococcus aureus (MRSA) imposes a risk on the patient herself as well as on other patients and on healthcare professionals because, in the case of an infection, substantial health problems will arise. Moreover, additional costs for health care will occur as well. This paper examines the incentives of German rehabilitation centers to implement prevention measures in order to avert MRSA transmissions and infections.
  
  
  METHODS
  Relying on a decision tree analysis, the expected healthcare cost per capita is calculated for the 3 strategies general screening, risk-based screening, both upon admission, and no screening at all. The values of the relevant parameters are identified by a review of the published literature.
  
  
  RESULTS
  From the perspective of a rehabilitation center, undertaking no screening at all minimizes the expected cost of treatment while the first strategy causes the highest cost. This ordering is robust with respect to multivariate sensitivity analyses.
  
  
  CONCLUSIONS
  In Germany, rehabilitation centers currently are not reimbursed for the implementation of additional prevention measures against MRSA. Hence, as our analysis demonstrates, the financial incentive to implement MRSA screening turns out to be rather weak. This could well be inefficient for society because a substantial part of the benefit arising on other agents is not taken into account. Our results can be used to indicate changes in the remuneration system that would provide rehabilitation centers with an appropriate incentive for MRSA prevention. Moreover, hygiene regulations enacted recently such as the change in the Infection Prevention Act or the Medical Hygiene regulations emphasize the significance of an appropriate hygiene regimen, thus fostering MRSA prevention.
authors.affiliation: Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Rechts- und Staatswissenschaftliche Fakultät, Ernst-Moritz-Arndt-Universität Greifswald.
authors.forename: F
authors.initials: F
authors.lastname: Claus
authors.affiliation: Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Rechts- und Staatswissenschaftliche Fakultät, Ernst-Moritz-Arndt-Universität Greifswald.
authors.forename: W
authors.initials: W
authors.lastname: Ried
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics; D003428:Cross Infection / Q000191:economics* / Q000517:prevention & control; D005376:Financial Management / Q000379:methods; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus; D018803:Models, Economic; D011315:Preventive Medicine / Q000191:economics / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000191:economics* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*