Cost analysis of surgical procedures for toxic nodular goiter

Effective by January 1, 1993, the Federal Care Rate Regulation (Bundespfleg esatzverordnung; BPflV) has started increased competition between hospitals by introducing performance related reimbursements. All three categories of flat payments, Fallpauschale (FP), Sonderentgelt (SE) and Budget-patient ( BP), apply to toxic nodular goiter surgery, governed solely by the extent o f thyroid resection. Unlike FP 2.01 and FP 2.02 which do not cover all surg ical expenses, the BP flat rate provides a comparatively generous refund fo r total thyroidectomy. With the oncoming reduction of upper values for residual radioactivity, hos pitalization will fall after radioiodine therapy, resulting in lower overal l refunds. With this anticipated fall in reimbursement, refunds for radioac tive therapy must be increased in the near future to ensure adequate financ ial compensation. Economic arguments for either therapeutic option will the n cease to play a major role, allowing medical therapeutic considerations t o prevail.