[Management of the acute coronary syndrome under German diagnosis related groups in 2005/2006].

In Germany, patients with acute coronary syndromes are often primarily admitted to hospitals without PCI (percutaneous coronary intervention) facilities. It is known, that this leads to considerable delays in contact-to-balloon time, which may trigger enhanced mortality and morbidity of these coronary events. The new German hospital reimbursement system, which is based on Diagnosis Related Groups, may contribute by different incentives to this unadverted result. Hospitals gain more money, if patients remain longer, and admitting patients by transfer from other hospitals is less profitable than primary admittance. Transport reimbursement back to basic hospitals is not provided by public insurance. The German Cardiac Society has submitted proposals to recalculate the transfer cases of patients with acute coronary syndromes for several years without success. The present paper discusses possible and necessary changes in the reimbursement system. As a main result, the system will not be changed as proposed. The reason is, that-compared to the whole volume of hospital treatment cases-the volume of transfer cases with acute coronary syndromes is not large enough to justify changes in the reimbursement rules by economic considerations. The paper discusses the consequences of a hospital reimbursement system that can only be adapted to changed conditions by economic but not by medical reasons.