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Rheumatology Advance Access originally published online on August 5, 2008
Rheumatology 2008 47(10):1527-1534; doi:10.1093/rheumatology/ken315
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany

J. Zeidler1, T. Mittendorf1, G. Vahldiek2, H. Zeidler3 and S. Merkesdal4

1Center for Health Economics, Leibniz University Hannover, 2Kaufmaennische Krankenkasse – KKH, 3Rheumatologikum and 4Medical School of Hannover, Department for Rheumatology and Immunology, Hannover, Germany.

Correspondence to: J. Zeidler, Leibniz Universität Hannover, Center for Health Economics, Koenigsworther Platz 1, D-30167, Hannover, Germany. E-mail: jz{at}ivbl.uni-hannover.de


  Abstract

Objectives. To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany.

Methods. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost–cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented.

Results. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of {euro}2047 and {euro}1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were {euro}2067 ({euro}1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation.

Conclusions. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

KEY WORDS: Rehabilitation, Inpatient rehabilitation, Outpatient rehabilitation, Cost analysis, Musculoskeletal disorders, Germany

Submitted 18 February 2008; revised version accepted 7 July 2008.
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