The European Journal of Public Health Advance Access originally published online on June 14, 2007
The European Journal of Public Health 2008 18(1):85-91; doi:10.1093/eurpub/ckm059
Health Services |
Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting
P. Hensen1,2, S. Beissert1, L. Bruckner-Tuderman3, T. A. Luger1, N. Roeder2 and M. L. Müller2,3
1 Department of Dermatology, University of Münster, D-48149 Münster, Germany
2 DRG-Research-Group, University of Münster, D-48129 Münster, Germany
3 Department of Dermatology, University of Freiburg, D-79104 Freiburg, Germany
Correspondence: Peter Hensen, MD, MA, Department of Dermatology, Medical Management, University of Münster, Von-Esmarch-Str. 58, D-48149 Münster, Germany, tel: +49 251 83 55676, fax: +49 251 83 56522, e-mail: hensenp{at}mednet.uni-muenster.de
Received October 26, 2006 , accepted May 18, 2007
Background: German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology. Methods: A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003–06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail. Results: It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed. Conclusions: The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.
Keywords: DRG, hospital care, impact, in-patient dermatology, length of stay