Solidarity with children and people with disabilities? : An economic analysis of reconstructive hip interventions in pediatric orthopedics

Abstract

Brain damage in childhood can be caused cerebral palsy (CP) or be due to other diseases. Disturbance of muscle tone results in consecutive development of hip subluxation. Hip reconstructive surgery can significantly improve the mobility and quality of care of children. However, the DRG for surgical care of these conditions has been increasingly devalued. In Germany, this has already led to areduction of pediatric orthopedics departments, accompanied by an important risk of insufficient treatment options for children and people with disabilities. The aim of this retrospective study was an economic analysis of pediatric orthopedic interventions using the example of neurogenic hip decentration. For this purpose, the revenue-cost situation in patients with CP or other causes of brain damage was evaluated at amaximum care hospital in the period of 2019-2021. The entire analysis period showed adeficit. The non-CP-group showed the most important deficit. In CP-patients, however, the plus decreased each year and resulted in adeficit in 2021. While the distinction between cerebral palsy and other forms of brain damage in children is usually not relevant for treatment, it is evident that the non-CP group is massively underfinanced. Overall, the negative economic balance of pediatric orthopedics in the field of neurogenic hip reconstruction is clearly revealed. In the current interpretation of the DRG system, children with disabilities cannot be offered cost-effective care at amaximum-care university center.