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Financing of certified centers: a willingness-to-pay analysis

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

Although care in certified breast centers is now established throughout Germany, numerous services are still not being reimbursed. This also affects other centers involved in the specialty of gynecology such as gynecological cancer centers, perinatal centers, and endometriosis centers. Although a certified center is entitled to charge additional fees, these are in most cases not reimbursed. Calculation of additional costs is limited by the fact that data from the Institute for the Hospital Reimbursement System (Institut für das Entgeltsystem im Krankenhaus, InEK) do not reflect interdisciplinary services and procedures. For decision-makers, society’s willingness to pay is an important factor in guiding decisions on the basis of social priorities. A hypothetical maximum willingness to pay can be calculated using a willingness-to-pay analysis, making it possible to identify deficiencies in the arbitrary setting of health budgets at the macro-level.

Materials and methods

In a multicenter study conducted between November 2009 and December 2010, 2,469 patients at a university hospital and at a non-university hospital were asked about the extent of their awareness of certified centers, the influence of centers on hospital presentation, and about personal attitudes toward quality-oriented reimbursement. A subjective assessment of possible additional charges was calculated using a willingness-to-pay analysis.

Results

In the overall group, 53.4 % of the patients were aware of what a certified center is and 27.4 % had specific information (obstetrics 40.0/32.3 %; mastology 66.8/23.2 %; gynecological oncology 54.7/27.3 %; P < 0.001). For 43.8 %, a certified center was one reason or the major reason for presentation (obstetrics 26.2 %; mastology 66.8 %; gynecological oncology 46.6 %; P < 0.001). A total of 72.6 % were in favor of quality-oriented reimbursement and 69.7 % were in favor of an additional charge for a certified center amounting to €538.56 (mastology €643.65, obstetrics €474.67, gynecological oncology €532.47). In all, 33.9 % would accept an increase in health-insurance fees (averaging 0.3865 %), and 28.3 % were in favor of reduced remuneration for non-certified centers.

Conclusions

The existence of certified centers is being increasingly recognized by patients. Additional charges for certified centers are generally supported. There is therefore a clear demand for them—from patients as well. This may be useful when negotiations are being conducted.

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Acknowledgments

We are grateful to the German Society for Mastology (Deutsche Gesellschaft für Senologie) for awarding this study the Klaus-Dieter Schulz Medical Care Research Prize at the Society’s 31st annual meeting in 2011.

Conflict of interest

We declare that we have no conflicts of interest.

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Authors and Affiliations

  1. Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany

    Falk C. Thiel, Thomas Hildebrandt, Efstratios Kotziabassis, Michael G. Schrauder, Mayada R. Bani, Andreas Müller, Christian R. Loehberg, Sebastian M. Jud, Peter A. Fasching, Matthias W. Beckmann & Michael Patrick Lux

  2. Department of Gynecology, St. Marien Hospital, Amberg, Germany

    Anton Scharl & Tanja Hauzenberger

  3. Institute of Pathology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany

    Arndt Hartmann

  4. Institute of Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany

    Rüdiger Schulz-Wendtland

  5. Department of Radiotherapy, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany

    Vratislav Strnad

  6. Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21–23, 91054, Erlangen, Germany

    Michael Patrick Lux

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  1. Falk C. Thiel
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Correspondence to Michael Patrick Lux.

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Thiel, F.C., Scharl, A., Hildebrandt, T. et al. Financing of certified centers: a willingness-to-pay analysis. Arch Gynecol Obstet 287, 495–509 (2013). https://doi.org/10.1007/s00404-012-2572-3

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