Systematische Erfassung von gesundheitsökonomischen Effekten durch regulatorische Einflüsse: Aufbau einer grundsätzlichen Methodik sowie Fallstudie zur Pankreaschirurgie

• Main Authors: Elsner, Christian, Wriedt, Corinna, Häckl, Dennis
• Format: Article
• Language: deu
• Published: German Medical Science GMS Publishing House 2015-09-01
• Series: GMS Medizinische Informatik, Biometrie und Epidemiologie
• Subjects: health systems research; geo simulation; health economics; hospital planning
• Online Access: http://www.egms.de/static/en/journals/mibe/2015-11/mibe000161.shtml

The German hospital market is influenced by different factors in it’s geo-spatial distribution of certain procedures. In Germany there are different hospital requirements as so called “minimum procedure quantities” and regulatory standards, which indirectly and directly control the distribution of procedures between hospitals. At the same time different literature studies show the health economic and mortality effects of different case redistributions as a result of minimum quantities and “learning curves”. An interlink is mostly missing.Objective: The aim of this study was to setup a system to systematically simulate and evaluate health economic effects due to regulatory standards and hospital planning. Additionally the system was methodologically applied to the exemplary field of pancreatic surgery. The effects were simulated using all structured intervention data from the quality reports of German hospitals and the exemplary data from pancreatic surgery “learning curves” and their health economic effects.Methods: On the basis of common available data from the year 2010 drawn from the standardized quality reports of all German hospitals combined with the Geo-localization data of the hospitals a simulation-database was generated. The quality reports were provided by the Federal Joint Committee (GBA). At the same time an XML-based structure language was developed, that allows the translation of health economic data into the format of the simulation.Results: As a result general statements about the distribution of procedures over Germany could be given for different regions and indications/procedures. In addition, the methodology to track and simulate effects due to a redistribution could be evaluated at the example of pancreatic surgery.Conclusion: The designed methodology and the generated database are useful to make a quick and accurate assessment of effects of any regulatory action. The database and the scheme could therefore serve to support future planning measures. In addition, they offer a standardized methodology, which makes effects objectively comparable. Based on the total number of 18.5 million cases in Germany, 2.5 million cases could be redistributed due to the simulation results generating positive effects. For the example of pancreatic surgery, the benefits would be at 289 life years gained (LYGs) per year.