Financing and Financial Problems of Care and Structures in the Field of Gynaecology and Obstetrics in the Year 2011-DRG System and Inpatient Care with Urogynaecology and Benign and Malign Gynaecological Surgery Second Paper of the Financing Commission of the DGGG e.V. - Part II

The public discussion about health care financing has an enormous relevance for the field of gynaecology and obstetrics. This second part of the paper of the financing commission of the DGGG presents essential financial aspects and problems, influencing our speciality. Among other aspects, the inputs of the DRG system are discussed for our field. The representation of all levels of care and all German states in the InEK calculation system is still a problem. Regarding the inpatient care, the number of cases has decreased by 23% over the last years due to the shift to the outpatient setting. Surgeries in the outpatient setting have increased by 31.5% from the year 2004 to the year 2008 (all specialities). Moreover, a decrease of obstetric cases by 5.7% and cases directly associated with birth by 7.3% has to be mentioned. Altogether, our field has lost 6.8% of all inpatient cases over the last years. The economic pressure is still high and it is difficult to maintain cost recovery. Regarding the personal resources, legal demands are problematic for perinatal centres, e. g. loss of the on-call duty possibility, availability of medical specialist expertise and necessity of permanent standby service of the head of the perinatal centre. Further problems of the inpatient setting concern the field of urogynaecology (lack of young academics, new technical procedures with lack of data, missing representation of complex surgeries and lack of reimbursement in case of surgeries in the outpatient setting) and the benign and malign gynaecological surgery. While standard procedures are almost represented in the DRG system, there is still a high demand for development of appropriate reimbursement for complex and infrequent case constellations, interdisciplinary procedures and simultaneous multiplex surgeries. The collaboration of all colleagues is essential.