[2d Report on increasing volume of diagnostic and interventional heart catheterization in hospitals and private practice in Germany 1990-1999]

Abstract

Despite all warnings from the German Ministry of Health, the healthcare insurances and the media, the number of diagnostic (DIAG) and therapeutic (PCI) cardiac catheterizations is continuously growing in hospitals and in private practices. From 1997 to 1999, the number of DIAG increased from 478837 to 561623 and PCI from 135925 to 166132. The average number of DIAG per institution decreased from 1482 in 1997 to 1324 in 1999 and the average number of PCI from 535 to 479. The number of DIAG-performing hospitals increased from 256 to 315 and that of DIAG-performing private practices from 67 to 109. The number of PCI-performing hospitals increased from 211 to 278 and the corresponding private practice locations from 43 to 69. In 1999, 18% of all DIAG and 15% of all PCI in Germany was performed in private practice. Since 1994, the average number of DIAG per private practice continuously decreased as well as the average number of PCI per private practice since 1997. This decrease was more pronounced in private practice (DIAG 378/lab and PCI 111/lab) than in hospitals (DIAG 68/lab and PCI 35/lab). Possible reasons for this trend are an increasing number of low volume centers, a more rigid indication for DIAG and PCI due to quality control programs, and the reduction of reimbursement incentives for social healthcare insured patients in private practice. The real optimal need for DIAG and PCI in Germany, however, has to be determined.