Breast cancer care in Western countries has reached a considerable level of quality and standardization, which has contributed to the decline in breast cancer mortality. Certified Breast Cancer Centers (BCC) represent an important element of this development. Related to changes in reimbursement and growing costs, BCC face economic constraints which ultimately could endanger the achievements of the past. Thus, BCC have to optimize their care strategies from an economic perspective, particularly by increasing efficiency but also by adapting their service portfolio. This could result in competitive advantages and additional revenue by increasing case numbers and extra charges to patients. Furthermore, an intensification of collaboration with the outpatient sector resulting in an integrated and managed ‘trans-sectoral' care approach which could allow to shift unprofitable procedures to the outpatient sector - in the sense of a win-win situation for both sectors and without loss of care quality - seems reasonable. Structured and specialized consulting approaches can further be a lever to fulfill economic requirements in order to avoid cuts in medical care quality for the sake of a balanced budget. In this review, economic constraints of BCC with a focus on the German healthcare system and potential approaches to ameliorate these financial burdens are being discussed.

1.
Statistisches Bundesamt: Gesundheit. Krankheitskosten. Fachserie 12, 2010, Reihe 7.2, pp. 1-45.
2.
Statistisches Bundesamt: Statistisches Jahrbuch - Deutschland und Internationales. Gesundheit 2012;4:115-151.
3.
Beckmann MW, Brucker C, Hanf V, et al.: Quality assured health care in certified breast centers and improvement of the prognosis of breast cancer patients. Onkologie 2011;34:362-367.
4.
Kreienberg R: Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms Leitlinie (Langversion). Germering/ München, Zuckschwerdt, 2012.
5.
Barni S, Venturini M, Molino A, et al.: Importance of adherence to guidelines in breast cancer clinical practice. The Italian experience (AIOM). Tumori 2011;97:559-563.
6.
Schwentner L, Wolters R, Wischnewsky M, et al.: Survival of patients with bilateral versus unilateral breast cancer and impact of guideline adherent adjuvant treatment: a multi-centre cohort study of 5,292 patients. Breast 2012;21:171-177.
7.
Beckmann MW, Adler G, Albers P, et al.: Onkologie Dreistufenmodell optimiert Behandlung unter Kostendeckung. Wie die künftigen Strukturen der onkologischen Versorgung in Deutschland aussehen sollten. Dtsch Ärztebl International 2007; 104:3004.
8.
Augurzky B, Gülker R, Krolop S, et al.: Krankenhaus Rating Report 2011. Die fetten Jahre sind vorbei. Executive Summary; in RWI Materialien, Heft 67, Essen, RWI, 2011.
9.
Krolop S: Krankenhausversorgung am Wendepunkt. Accenture 2012; pp 1-2.
10.
Ahrens U, Bocking W, Kirch W: (DRG introduction in Germany. Options for action of hospitals). Med Klin 2005;100:26-31.
11.
Herwartz H, Strumann C: On the effect of prospective payment on local hospital competition in Germany. Health Care Manag Sci 2012;15:48-62.
12.
Greiling M, Quint U: (Clinical pathways from an economic viewpoint). Orthopade 2010;39:752-757.
13.
Roohan PJ, Bickell NA, Baptiste MS, et al.: Hospital volume differences and five-year survival from breast cancer. Am J Public Health 1998;88:454- 457.
14.
Oberaigner W, Stuhlinger W: Influence of department volume on cancer survival for gynaecological cancers - a population-based study in Tyrol, Austria. Gynecol Oncol 2006;103:527-534.
15.
Beckmann MW, Bani MR, Loehberg CR, et al.: Are certified breast centers cost-effective? Breast Care (Basel) 2009;4:245-250.
16.
Landercasper J, Tafra L: The relationship between quality and cost during the perioperative breast cancer episode of care. Breast 2010;19:289-296.
17.
Wagner S, Bani M, Fasching P, et al.: Ist ein Brustzentrum finanzierbar? Berechnung einzelner Leistungen am Beispiel des Universitäts-Brustzentrums Franken (UBF). Geburtsh Frauenheilk Geburtshilfe und Frauenheilkunde 2008;68:1178-1183.
18.
Thiel FC, Scharl A, Hildebrandt T, et al.: Financing of certified centers: a willingness-to-pay analysis. Arch Gynecol Obstet 2012;Epup ahead of print.
19.
Beckmann MW, Kaufmann M: Ist die Versorgung von Patientinnen mit Mammakarzinom im derzeitigen Vergütungssystem finanzierbar - Wird Qualität auch bezahlt in Brustzentren? Geburtshilfe und Frauenheilkunde 2007;67:957-958.
20.
Hewitt M, Herdman R, Holland J, Council NR (eds): Meeting Psychosocial Needs of Women with Breast Cancer. Washington, National Academies Press, 2004.
21.
Goldmann-Posch U, Martin RR: Über-Lebensbuch Brustkrebs: Die Anleitung zur aktiven Patientin - In Abstimmung mit international anerkannten Brustkrebs-Experten. Stuttgart, Schattauer GmbH, 2012.
22.
Wiegard K, Albert U-S, Zemlin C, et al.: Psychische Belastung von Brustkrebspatientinnen: Screening und psychoonkologischer Unterstützungswunsch als Indikatoren der Lebensqualität. Senologie 2012;9:173-179.
23.
Vogl M: Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany. Health Econ Rev 2012;2:15.
24.
Matsuno RK, Pagano IS, Maskarinec G, et al.: Complementary and alternative medicine use and breast cancer prognosis: a pooled analysis of four population-based studies of breast cancer survivors. J Womens Health (Larchmt) 2012;21:1252- 1258.
25.
Weissflog G, Gotze H, Klinitzke G, et al.: (Better patient orientation through certified cancer centres in oncological care? Patient satisfaction in breast cancer patients in certified breast cancer centres and noncertified hospitals). Z Psychosom Med Psychother 2011;57:343-355.
26.
Rave N, Geyer M, Reeder B, et al.: Radical systems change. Innovative strategies to improve patient satisfaction. J Ambul Care Manage 2003; 26:159-174.
27.
Wallwiener D, Brucker SY: Zertifizierte multidisziplinäre Brustzentren: Ein Implementierungsprojekt der Deutschen Krebsgesellschaft und der Deutschen Gesellschaft für Senologie in Partnerschaft mit der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe. Senologie 2011;8:92-95.
28.
Porter ME, Guth C: Chancen für das deutsche Gesundheitssystem von Partikularinteressen zu mehr Patientennutzen. Berlin, Springer/Gabler, 2012.
29.
Hopmeier T, Lux MP, Hoellthaler J, et al.: Können Organkrebszentren und Onkologische Zentren die Versorgungsqualität optimieren und gleichzeitig ökonomischer arbeiten? - Ein Best Practice Modell für die Entwicklung Onkologischer Exzellenzzentren. Senologie 2012;9:A70.
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