Analysis of Costs and Profits of Ambulatory Care of Marfan Patients after Initiation of a Novel German Legal Directive (S 116 b SGB V)

作者：Manow Marie Luise; Paulsen Nesrin; Rybczynski Meike; Mir Thomas; Bernhardt Alexander M J; Treede Hendrik; Ohm Gunda; Fuisting Bettina; Rehder Uwe; Meier Florian; Vogler Marina; Meinertz Thomas; Overlack Karin; von Kodolitsch Yskert^*

来源：Medizinische Klinik, 2010, 105(8): 529-537.

DOI：10.1007/s00063-010-1090-y

• Marfan syndrome
• Loeys-Dietz syndrome
• Costs
• Reimbursement
• Ambulatory care

Analysis of Costs and Profits of Ambulatory Care of Marfan Patients after Initiation of a Novel German Legal Directive (S 116 b SGB V)
Background: The Marfan syndrome is a typical rare disease with multiorgan involvement and the need for specialized interdisciplinary medical care. A novel German legal directive according to section sign 116 b of the Social Statutes Book V (S 116 b SGB V) improves options for reimbursement and thus encourages specialized hospitals to provide ambulatory care for rare diseases such as Marfan syndrome. The authors provide the first economic analysis of S 116 b in a German Marfan center.
Methods: The costs were assessed in 184 cases with Marfan syndrome receiving medical care in the Hamburg Marfan Clinic. The authors assessed the financial profit both according to payments received from invoices established according to the S 116 b directive [reimbursement((S116b))] and from calculations according to S 117 SGB V [reimbursement ((S117))].
Results: A total of 117 patients traveled to the Marfan clinic (64%) < 50 km, 27 patients (15%) between >= 50 and <= 100 km, and 40 patients (22%) > 100 km. The total costs for ambulatory care were 71,606.28 Euros. The reimbursement((S116b)) was 55,549.87 Euros and the reimbursement((S117)) was 11,776.00 Euros.
Conclusions: Many patients accept long distances of traveling to receive specialized ambulatory medical care. However, for optimal patient management specialized centers need to cooperate intensively with local health care providers. The novel legal directive according to S 116 b has significantly improved reimbursement for Marfan centers and allows for improving the quality of medical care.

• 出版日期2010-8