Abstract
BACKGROUND: The introduction of DRG-based billing of inpatient hospital services in Germany in 2003 has led to a significant change in patient care. In general, the introduction was criticized as a step towards an increasing shift of inpatient services to the outpatient sector and significantly shorter lengths of stay (LOS) with potentially worse inpatient care became a concern. OBJECTIVE: To assess and analyse the change in LOS and annual numbers of inpatient treatment in patients with epilepsy between the years 2000 and 2020. MATERIAL AND METHODS: Using interrupted time series analysis (ITSA), data from the Federal Statistical Office on case numbers and length of stay of patients with epilepsy in Germany were statistically analyzed for significant trend changes and their timing. RESULTS: The ITSA detected no significant change of trend according to the overall LOS over time; however, there were significant trend changes in several LOS categories with a tendency toward shorter hospitalization times. All identified change points were temporally associated with the introduction of DRGs. These results could not be reproduced for inpatient rehabilitation services, which are still predominantly reimbursed based on daily rates. In addition, there was an increase in specialized epileptological inpatient services, especially video EEG monitoring. CONCLUSION: The introduction of DRG-based billing of inpatient hospital cases has led to a significant increase in shorter as well as a decrease in longer inpatient treatment. Whether and to what extent this has also led to a decreased treatment quality cannot be deduced from the data used for this study but warrants further analysis.