Health Economic Aspects

  • Michael Weißer
  • Hubertus Rosery
  • Tonio Schönfelder
Open Access


The costs incurred for knee and hip arthroplasty depend on the different type of treatments provided within the chain of medical care. Indirect costs of the disease, such as the incapacity to work resulting from the underlying diseases and intangible costs which cannot be evaluated in monetary terms, must also be taken into account. Patient care is financed through established remuneration systems. According to different publications, data extrapolations have shown that German statutory health insurances spent approximately 1.4 to 1.6 billion euros per year on hospital treatments for hip arthroplasty between 2003 and 2009. With regard to knee arthroplasty, expenditure for the same period was estimated at 1.0 to 1.3 billion euros per year. The direct costs for the associated inpatient stays are financed through case-based fees, which are in turn based on the actual average hospital costs. The most commonly remunerated case fees (hip arthroplasty/knee arthroplasty) have shown cost increases of a few percentage points over the last few years which are mainly due to the rising costs of personnel. In the two case-fee groups, implant costs constitute 21 % of the total cost for hip treatments and 25 % of the total cost for knee treatments. Particularly complicated cases such as infected hip endoprostheses are relatively more costly. With regard to indirect costs, the diagnosis »Osteoarthritis of hip« (ICD-10 M16) resulted in 2,585,157 days of incapacity to work amongst compulsory statutory health insurees (excluding pensioners) in 2011. For »Osteoarthritis of knee« (ICD-10 M17) the figure was almost double at 4,971,052. Some patients who are in employment are unable to return to work despite having undergone a joint replacement and either have to change profession or accept a loss of income that includes social security contributions. Osteoarthritis, which is the most common reason for hip or knee replacements, is associated with a significant, increasing and in part immeasurable disease burden. International studies have demonstrated that the disease is accompanied by a high degree of suffering on the part of the patient as the large majority (70 % or more) would be personally willing to finance the hip or knee arthroplasty at their own cost if the procedures were not included amongst those reimbursed by health insurance systems. Hospitals in Germany finance the costs of arthroplasty with one of several possible arthroplasty case fees selected according to the specific service provided and the circumstances of each case. The case fees are based on the average costs of a given treatment. The case fee figures in 2015, which were based on certain benchmarks, ranged between approximately 6,400 euros and 17,300 euros. However, case fees do not always seem to cover the hospital costs, particularly in the treatment of more complicated cases.


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Authors and Affiliations

  • Michael Weißer
    • 1
  • Hubertus Rosery
    • 1
  • Tonio Schönfelder
    • 2
  1. 1.AiM GmbH - Assessment in Medicine, Research and ConsultingLörrachGermany
  2. 2.IGES Institut GmbHBerlinGermany

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