Regional differences in healthcare utilisation of epilepsy patients in Germany

Patients with epilepsy often require a specialized treatment, which may differ because of the responsibility of the federal states for healthcare policy in Germany.

To analyze regional differences in healthcare structures based on inpatient hospital cases of epilepsy patients between 2000 and 2020 in relation to specialized treatment offers.

The inpatient hospital cases of the German federal states were evaluated using the Friedman test and time series trend analysis. A state-specific inpatient underutilisation or overutilisation of inpatient hospital care outside the registered state was analyzed by comparing residence-related and treatment site-related case numbers with a threshold of ±5%.

After age adjustment, significantly more inpatient cases were found in the “new federal states” compared to the “old federal states” (p < 0.001); the highest number of cases nationwide was found in Saarland with 224.8 ± 11.5 cases per 100,000 inhabitants. The trend analysis showed an increase in cases until the end of 2016 with a trend reversal from 2017 and a further significant decrease in hospital cases in the COVID year 2020. A relative inpatient underutilisation was shown for Brandenburg, Lower Saxony, Rhineland-Palatinate, Saxony-Anhalt, Schleswig-Holstein and Thuringia. Additional, possibly compensatory, inpatient care was found for all city states (Hamburg, Bremen and Berlin) and the federal state of Baden-Wuerttemberg. In federal states with a relative underutilsation of inpatient care and/or high inpatient hospital case numbers, there was often a lower availability of specialized epilepsy centers, specialized outpatient clinics and epilepsy outpatient clinics.

In Germany there are state-specific differences in the structure of care, with higher inpatient hospital care in the “new federal states” and Saarland. In addition, there were federal states with disproportionately higher treatment of patients from other federal states. A potential influencing factor may be the availability of centers with specialized treatment for epilepsy patients.