Financing in knee arthroplasty: a benchmarking analysis
Effenberger, H., Rehart, S., Zumstein, MD et al.Knee
Introduction
Flat rate payment and “diagnosis related groups” (DRG) in knee arthroplasty offer incentives to save expenses. A cost-benefit analysis exactly compares all expenses to revenues. This requires patient-related assessment of treatment costs in terms of cost-unit accounting. This study compared expenses of knee arthroplasty in Austrian, German and Swiss clinics.
Materials and methods
A survey of primary and revision surgery was conducted and data — divided into cost elements and cost centers — were collected from three Austrian, five German and one Swiss clinic.
Results
Personnel costs for medical services were lower in Austria (€ 617) than Germany (€ 1.271) and Switzerland (€ 1.305). Nursing costs to € 1.432 in Austria, € 1.011 in Germany, € 2.525 in Switzerland. Costs for medical tech. services were lower in Austria (€ 261) than Germany (€ 848) and Switzerland (€ 1,093). Average costs for medication to € 491 in Austria, higher than Germany (€ 118), lower than Switzerland (€ 506). Costs for implants were higher in Austria (€ 2.558) than Germany (€ 2.134), highest in Switzerland (€ 3.619). Regarding case numbers, these cost elements showed significant differences ( P.<0.001). Costs for non-medical goods were similar (Austria € 478, Germany € 427, Switzerland € 488). Personnel and material infrastructure was higher in Austria (€ 516) than Germany (€ 360); € 1,658 in Switzerland. Administration was much higher in Austria (€ 2,330) than Germany (€ 1,461) and Switzerland (€ 1,431). Costs for primary knee arthroplasty to € 8,684 in Austria, € 7,631 in Germany, € 12,625 in Switzerland.
Conclusions
The proportion for personnel costs (medical, nursing, med.-tech.) Of total costs was higher in Germany (41%) than Austria (26.6%) and Switzerland (39.9%). Implant costs were proportionally nearly the same in Austria (29.5%) than Germany (28%) and Switzerland (28.7%). Administration was proportionally higher in Austria (26.8%) than Germany (19.1%) and Switzerland (11.3%). To lower the costs, the expenses for personnel and implants must be reduced. Ultimately, the potential for hospitals to save costs can be found here.
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