Financing of acute pain services in German hospitals

Erlenwein J, Waeschle RM, Bauer M, Koppert W, Meissner W, Pogatzki-Zahn E, Stamer UM, Petzke F

Abstract

Background: The aim of this study was to examine how human resources and costs of acute pain services (APS) are documented and covered. Methods: Heads of German anaesthesia departments were invited to participate in an online survey addressing human resources planning as well as provision of personnel and cost of supplies of their APS. Results: Answffs were received from 342 departments (response rate 38\%), 80\% (n=247) of the hospitals had an APS. Physicians for APS were included in the personnel planning in 24\% of the hospitals, nursing staff in 50\%. Personnel costs were most often covered by the budget of the anaesthesiology department 1(82\%), considerably less by the nursing directorate (16\%), an intra-hospital cost allocation (9\%), shared between departments (6\%), as a cost-centre (2\%), or by external sponsorship (1\%). `In addition, the cost of supplies was generally covered by. the department of anaesthesia (drugs 85\%, consumables 96\%, pumps 93\%, and maintenance costs 93\%). Only 21\% of APS documented the exact costs. 91\% of the APS had no separate burden centre. Cost-type accounting was done for drugs in 10\%, for consumables in 13\%, for pumps in 18\%, for, personnel expenses for catheter placement in 3\%, and for postoperative care of the catheters or patient-controlled analgesia pumps in 5\% of cases. Conclusions: Although many hospitals provide an APS, 75 and 50 percent of them did not foresee positions for doctors and nursing staff in their personnel planning, respectively. Personnel and supply costs were mostly covered by the department of anaesthesiology. There was a lack of documentation to explain the actual efforts and costs. For transparent financing of APS, a documentation of the actual efforts and costs would be of importance.