[Appendectomy with respect to flat fee and special rate charges. Cost analysis of open and laparoscopic operation]. / Die Appendektomie unter den Bedingungen von Fallpauschale und Sonderentgelt. Kostenanalyse bei offener und laparoskopischer Operation.

ABSTRACT

The introduction of flat charges per case and special fees, first put into effect on Jan. 1, 1996, has lead medical and administrative personnel to rethink how fixed daily hospital rates, costs individually determined by each hospital, and prime costs for hospital and nursing charges will be reimbursed. The amount paid for flat charge cases and special fees (in German Marks) are currently the same nationwide. This applicable system of billing consists of a combination of diagnosis (ICD 9) and the type of therapy administered after each specific operation (ICPM). Between Jan. 1, 1996 and Dec. 31, 1996 we had 78 cases, where detailed personnel and relevant costs were recorded with the aid of three sheets of medical records and two reports for each patient. When comparing expenditures and compensation, there were deficits in 75 cases and surpluses in 3. This existing pressure to cut costs should not be allowed to lead to uncritical medical judgement. The major costs of an operation are for disposable materials, especially for the use of the endo-cutter. Laparoscopic appendectomies, on selected patients in our clinic, has created a deficit when covering costs for open appendectomies. The knowledge we have gained from this now enables us to balance out the deficit.