[Structure and reimbursement in obstetrics - are births in level I perinatal centres economically sound?].

INTRODUCTION: The standardization of the profit in the public health system causes the question if obstetrical departments of different structures can work cost-coveringly and which services in the DRG-system operate in deficit or profitably. This problem mainly refers to the hospitals of obstetrical maximal care, namely the perinatal centre of level I.
MATERIAL AND METHODS: Based on the body cost accounting according to InEK-Matrix the average actual costs of an obstetrical department level IV, a perinatal centre level I and university hospitals were found out for the obstetrical DRGs and compared with the profits calculated by InEK. An analysis of the costs was carried out concerning the cost relevance for different cost areas.
RESULTS: Spontaneous delivery was the service that turned out to be cost-covering in all structures. The real costs of caesarean sections, however, as well as those of some vaginal kinds of delivery, mainly pre-mature births and complicated diagnoses turned out to be not cost-covering. However, the perinatal centre was able to compensate the deficit by the high number of vaginal deliveries. The actual personel costs for physicians were higher in the perinatal center than the InEK-calculation for all obstetrical DRGs. The costs of nursery and the costs of the non-medical infrastructure were partly smaller than those of the InEK-calculation.
CONCLUSION: A perinatal center level I can operate cost-coveringly on the basis of the DRG system. To achieve this it's not necessary to increase the number of caesarean sections, but what is needed instead is a high number of normal deliveries and an economical non-medical infrastructure and care. © Georg Thieme Verlag KG Stuttgart · New York.