[The regional psychiatry budget (RPB): a model for a new payment system of hospital based mental health care services].
OBJECTIVE
To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) on costs and effectiveness of care.


METHODS
Patients with a diagnosis according to ICD-10 F10, F2 or F3 were interviewed in the model region (MR, n = 258) and a control region (CR, n = 244) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HoNOS, SCL-90R, PANSS, BRMAS / BRMES), functioning (GAF, SOFAS) and quality of life (WHOQOL-BREF, EQ-5D). Use of care was determined semi-annually.


RESULTS
There were no significant differences in the development of psychopathology and quality of life between MR and CR. In the MR, functioning of patients with schizophrenia and affective disorders improved significantly more strongly. The development of total mental health care costs was not different between MR and CR. However, the costs of office based mental health care increased slightly more strongly in the MR, indicating a small cost-shift from the RPB to extrabudgetary financed services.


CONCLUSIONS
The RPB showed slight advantages regarding the effectiveness of care and did not significantly change the total mental health care costs.
König
Hans-Helmut
HH
Universität Leipzig, Professur für Gesundheitsökonomie, Klinik und Poliklinik für Psychiatrie.
Heinrich
Sven
S
Heider
Dirk
D
Deister
Arno
A
Zeichner
Dirk
D
Birker
Thomas
T
Hierholzer
Cornelia
C
Angermeyer
Matthias C
MC
Roick
Christiane
C
D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D002017:Budgets; D002204:Capitation Fee; D015331:Cohort Studies; D003361:Cost Allocation; D003362:Cost-Benefit Analysis; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006778:Hospitals, Psychiatric / Q000191:economics*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation; D008875:Middle Aged; D018803:Models, Economic; D019964:Mood Disorders / Q000191:economics / Q000523:psychology / Q000534:rehabilitation; D009313:National Health Programs / Q000191:economics*; D010343:Patient Admission / Q000191:economics*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology; D011788:Quality of Life; D012559:Schizophrenia / Q000191:economics / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D016896:Treatment Outcome