Caesarean sections and the like: Surgery and treatment in hospitals
Destatis, 2 February 2010
Since early in 2004, hospital services have been remunerated on the basis of case flat rates. This means that remuneration is no longer based on a patient's length of stay in hospital, but depends on the diagnosis and the treatment required. The system of case flat rates was introduced with the aims of reducing the length of stay in German hospitals, standardising the remuneration for medical services provided in hospitals, and containing the increasing costs of hospital stays. Ever since, the length of hospital stay has been declining, while the number of operations and treatments has increased more quickly than the number of patients.
More operations and treatments
Operations and treatment measures
Overall, 41.8 million operations and medical procedures were carried out on the about 17 million inpatients who received full-time hospital care in 2008. As compared with the preceding year, this was an increase of 5.2%. Compared with 2005, when hospital statistics based on case flat rates (DRG statistics) were introduced, the increase amounted to as much as 15.7%.
At 23.1%, the increase in medical imaging diagnoses (e.g. X-ray scans) was higher than that in supplementary measures (8.9%) and operations and diagnostic measures (both just under 13%). The proportion of operated patients has remained nearly constant since 2005, accounting for around 40%. The average number of measures per patient has since risen from 2.2 to 2.5.
The number of treatment cases is highest in internal medicine departments
Specialist departments
In 2008, the greatest proportions of patients were treated in specialist departments for internal medicine (5.4 million cases), general surgery (3.3 million cases) and gynaecology and obstetrics (2.2 million cases). The patients' average length of hospital stay was 6.5 days in the two first mentioned departments and 4.4 days in the last mentioned department.
Owing to the wide range of geriatric illnesses treated, patients stayed for especially long periods of time (15.7 days) in geriatric departments. However, the length of stay in these specialist departments has declined since 2005 as it has done in nearly all other hospital departments. On average, the length of stay in all hospitals covered by the DRG statistics statistics decreased by 0.6 days between 2005 and 2008. Nonetheless, Germany, together with Switzerland, ranks first among the twenty-three European OECD countries with regard to the longest average length of stay in general hospitals.
Cardiac diseases are the main diagnosis for hospital stay
Secondary diagnoses
The patients' average age rose from 52.5 to 53.6 years between 2005 and 2008. Leaving hospital care for healthy newborns out of account, cardiac diseases were the most frequently occurring main diagnosis for hospital stays.
As the patients' age increases, there is a marked rise in the average number of secondary diagnoses that are made in addition to the main diagnosis. This reflects the higher probability of multiple diseases, called multimorbidity, observed with increasing age and of complications during treatment. In 2008, about four secondary diagnoses were, on average, registered per case.
Deliveries still rank among the most frequently billed case flat rates
Despite the drop in births, hospital care for healthy newborn children (535 900 cases) was the most frequently billed case flat rate (DRG) in 2008, followed by esophagitis, gastroenteritis and miscellaneous digestive disorders (421 400 cases) and deliveries without complicating diagnosis (339 500 cases). Caesarean sections are among the operations most frequently performed on women. According to the basic data on hospitals, about every third woman giving birth in hospital delivered her child by Caesarean section in 2008, compared with only every seventh woman in 1991. According to calculations using data from the DRG statistics, hospitals on average charged about EUR 1 500 for a normal delivery and about EUR 2 550 for a Caesarean section provided there were no complicating diagnoses.
Author:
Jutta Spindler – Federal Statistical Office
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