The Role of Regulatory Policies in Shaping Outpatient Cancer Treatment in Germany: A Comparative Perspective

Introduction: The German healthcare system has traditionally separated sectors for inpatient and outpatient care. Recently, outpatient care was increasingly integrated into hospital settings, in particular for cancer patients. This transition has been gradual, leading to inconsistencies in coordination, quality assurance and reimbursement. This study compares how different reimbursement frameworks impact outpatient care for patients with diffuse large B-cell lymphoma (DLBCL) and esophagogastric junction (EGJ) adenocarcinoma at the University Hospital of Cologne (UHC) and its affiliated medical service center (Medizinisches Versorgungszentrum, MVZ). Methods: A retrospective analysis (2018-2021) was conducted using clinical and billing data of the outpatient unit of the Department I of Internal Medicine (Dept I) and the MVZ. Patients with DLBCL or stage IV EGJ adenocarcinoma receiving first-line therapy were included. Adherence to S3 guideline-based reference care pathways was assessed alongside additional service provision. Statistical analyses included Mann-Whitney U tests and regression models. Results: Results: Among 93 eligible patients (DLBCL, n=65; EGJ, n=28), DLBCL patients treated at the Dept I showed significantly higher adherence to standard procedures during primary staging and pre-therapeutic assessments compared to the MVZ (p < 0.01). The Dept I more frequently delegated routine tasks to general practitioners during chemotherapy cycles 4-6 (p < 0.01) and provided more additional medical consultations during treatment (p < 0.01). In contrast, the MVZ used multiday chemotherapy schedules more frequently than the Dept I (p < 0.05). No significant differences were observed for EGJ patients. Overall, both settings maintained equal levels of guideline-compliant care. Conclusion: Regulatory frameworks did not impact overall service volume but influenced certain aspects of care delivery. The outpatient unit of the Dept I adopted a more integrated, service-oriented approach, while the MVZ emphasized operational efficiency. Overall, the findings show that reimbursement schedules influence the operational standards of cancer care.