Zukunft der stationären Versorgung in Gynäkologie und Geburtshilfe

Abstract

Background: The typical gynecology and obstetrics department is characterized by small, declining numbers of cases and economic difficulties. Out of 1717 general hospitals in 2007, 982 had a gynecology and obstetrics department. On average, 2250 patients were treated in each clinic; 1540 with obstetric and approximately 660 with gynecologic primary diagnoses. Although the number of specialist departments had already declined by 11% by 2013, the challenges are still present. This is due to demographic development and the increasing trend towards ambulant treatment, particularly in gynecology. Objective: The current structure—with many small facilities and high contingency costs—is not, on average, economically viable; in the presence of declining case numbers, it will become even less viable. A further, more extensive pooling of capacities, with the abandonment of locations is inevitable. The effects of such a concentration process are analyzed. Materials and methods: For the analysis, administrative data in accordance with § 21 KHEntgG are available for all 1717 diagnosis-related group (DRG) hospitals for 2007. Using these data, and considering the demographic development and expected trend towards ambulant treatment, the number of cases arising up until 2030 is extrapolated. The hospital locations demonstrating a number of cases too low to enable economic viability are identified. In a simulation, these locations are closed and the resultant travel times to the next available location are analyzed. Results and discussion: In 2020, the number of cases can be expected to be reduced by 12% compared to 2007; in 2030, by 27%. A restructuring process should consider urban and rural regions separately. In rural regions, pooling of services in health centers seems rational, whereas complex cases would be treated on a stationary basis in urban centers. In 2020, less than 600 clinics could provide the necessary care, without endangering accessibility; by 2013, less than 400.