Centralization, Specialization, and Outpatient Care for Head and Neck Tumor Patients – Challenges for Patients and Physicians

Introduction Demographic change in Germany goes along with an aging, more multimorbid population. At the same time, urbanization trends, medical overcapacities, and rising, also innovation-related, care costs are being observed in presence of a tight healthcare budget. Centralization, specialization, and outpatient care are intended to provide relief and can be partly controlled by modifications to remuneration or rather the diagnosis-related case group system (DRG) and the uniform assessment scale (EBM). This upheaval poses new challenges for patients and physicians.

MethodsN We performed a retrospective, monocentric cohort study on the development of patient volume, catchment area, treatment modality, and demographics at the Head and Neck Cancer (HNC) Center of the University Hospital Ulm with the inclusion of 2070 patients between the years 2011 and 2020.

Results The number (new diagnoses in 2011: 134 vs. 2020: 204) and mean age (2011: 61.5 years vs. 2020: 65.8 years; p < 0.0001) of HNC patients at the HNC Center Ulm increases over time. Patients tend to travel longer distances (2011: 54.4 km vs. 2020: 64.4 km; p = 0.05). At the same time, the mean number of consultations and treatments per patient and 5-year follow-up interval increases (at initial diagnosis 2011: 7.8 vs. 2016: 10.4; p = 0.0003), with the proportion of outpatient contacts increasing from 58.9% to 62.4% (p = 0.09) from 2011 to 2020.

Conclusion Clinical centers are gaining importance in the inpatient but also outpatient care of HNC patients in the course of the specialization, outpatientization, and centralization of the German health system; resulting consequences for patient care should be considered while planning and executing accordant restructuring strategies.

Conflict of Interest

The author declares that there is no conflict of interest.

Publication History

Article published online:
24 May 2022