How individualized is medicine today? The case of heart failure in the G-DRG system

Abstract

Heart failure is currently one of the most cost-intensive diseases in Germany. It also represents one of the most common reasons for hospitalization. Currently the remuneration of hospitals in the German DRG system (G-DRG) is carried out by using a lump sum for each case of inpatient treatment. The system must be able to map complex cases. This contribution aims to analyze how a pathway for clinical care is apparent for heart failure using the example of the base DRG F62. Therefore, a comprehensive data set from the University Medicine Greifswald is used. By analyzing cost homogeneity of the base DRG F62 it becomes clear, that there are high variations within case groups. Heart failure is treated in a very individualized way today. It is concluded, that highly complex diseases such as heart failure can challenge the G-DRG-system to its limits. Therefore, an adequate adjustment in order to reflect the risk for health care providers in an acceptable way will be required. Implementing methods for risk adjustment could be one possible solution.