TY - JOUR

T1 - Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany

AU - Zeidler, Jan

AU - Mittendorf, Thomas

AU - Vahldiek, G.

AU - Zeidler, H.

AU - Merkesdal, S.

N1 - Funding Information: health insurance fund with nearly 2 million insurants. In Germany, medical rehabilitation is reimbursed by statutory health funds and retirement funds. Rehabilitation for employed patients is funded by retirement funds whereas rehabilitation of unemployed patients is financed by health insurance funds. Therefore, the data of rehabilitation covered by health insurance funds represents only patients unable to work, retired and out of employment as well as housewives, students and other people in education or unemployed. All patients receiving a rehabilitation service in 2005 were extracted from the database and stored in a Microsoft Access database for data cleaning and further analysis.

PY - 2008/10

Y1 - 2008/10

N2 - Objectives. To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. Methods. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. Results. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of €2047 and €1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were €2067 (€1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. Conclusions. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

AB - Objectives. To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. Methods. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. Results. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of €2047 and €1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were €2067 (€1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. Conclusions. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

KW - Cost analysis

KW - Germany

KW - Inpatient rehabilitation

KW - Musculoskeletal disorders

KW - Outpatient rehabilitation

KW - Rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=52949110227&partnerID=8YFLogxK

U2 - 10.1093/rheumatology/ken315

DO - 10.1093/rheumatology/ken315

M3 - Article

C2 - 18682412

AN - SCOPUS:52949110227

VL - 47

SP - 1527

EP - 1534

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 10

ER -