Correlation between severity of disease and reimbursement of costs in neonatal and paediatric intensive care patients

Authors: Hoehn, Thomas¹; Drabik, Attyla²; Lehmann, Christian³; Christaras, Andreas⁴; Stannigel, Hans¹; Mayatepek, Ertan¹

Source: Acta Pædiatrica, Volume 97, Number 10, October 2008 , pp. 1438-1442(5)

Publisher: Wiley-Blackwell

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Abstract:

Aim: The aim of the present study was to investigate the correlation between neonatal, paediatric and adult disease severity scores and reimbursement by health insurances.

Methods: The setting was a university hospital's neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU). We performed a prospective study of all patients admitted over the 3-month study period. Data collected included five scoring systems to predict mortality or to quantify disease severity (Paediatric Index of Mortality [PIM], Paediatric Risk of Mortality [PRISM], Simplified Acute Physiological Score [SAPS], Score for Neonatal Acute Physiology [SNAP], Therapeutic Intervention Scoring System [TISS]) on a daily basis, the total reimbursement as calculated by the grouper according to the German diagnosis-related groups (DRG) system, age of the patient, length of stay (LOS), International Classification of Diseases (ICD)-10 and DRG diagnosis. Our intention was to determine the correlation between different neonatal, paediatric and adult scores (PIM, PRISM III, SAPS-II, SNAP, Core-10-TISS), and reimbursement by the health insurance on the basis of the German DRG system in its 2005 and 2007 version.

Results: No positive correlation between any score applied and reimbursement by the health insurance could be identified. Reimbursement was positively correlated to the length of hospital stay. Positive correlations could also be shown for some of the scores among each other.

Conclusion: We conclude that other scoring systems or measures of disease severity urgently need to be established to terminate the chronic underfunding of paediatric intensive care medicine in the developed countries.

Keywords: Diagnosis-related groups (DRG); Health care financing; Medical resources; Prediction of mortality; Scoring system

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1651-2227.2008.00926.x

Affiliations: 1: Department of General Pediatrics, Heinrich-Heine-University, Duesseldorf, Germany 2: Center of Clinical Trials, University Hospital Muenster, Muenster, Germany 3: Controlling, University Hospital Duesseldorf, Duesseldorf, Germany 4: Department of Pediatric Oncology, Hyperbaric Oxygen Therapy Unit, Heinrich-Heine-University, Duesseldorf, Germany

Publication date: 2008-10-01

Correlation between severity of disease and reimbursement of costs in neonatal and paediatric intensive care patients

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