Comparative cost analysis of outpatient and inpatient rehabilitation for cardiac diseases

Purpose: To examine costs of inpatient and outpatient rehabilitation for cardiac disorders from the perspective of a major statutory health insurance fund in Germany. Methods: A nationwide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analyzed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of in- and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. Results: Mean costs were 2,006 Euros for inpatient rehabilitation and 1,502 Euros for outpatient rehabilitation. No systematic differences were identified between in- and outpatient rehabilitation in costs for drugs and physical therapy in the year preceding and the year directly following the rehabilitation. The costs for hospital treatment in the year before rehabilitation were higher in inpatient rehabilitation, whereas in the year after rehabilitation no differences between in-and outpatient rehabilitation were seen. Conclusion: Assuming comparable medical outcome, outpatient rehabilitation seems to pose a superior alternative compared to inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health-care resources.