[Changes in mental health care by a regional budget: results of a pilot Project in Schleswig-Holstein (Germany)].
OBJECTIVE
In a region of Schleswig-Holstein, a regional budget was used to investigate which structural changes would be brought about by a financial plan which enables (clinical) treatment that defies rigid financial limits and makes flexible treatment in various settings possible.


RESULTS
In 5 years, the number of inpatient treatment places in the care region was reduced considerably. The length of stay per patient and year decreased by 25 %. Day care and outpatient treatment offers were expanded substantially and new treatment concepts were established. The quality of treatment remained safeguarded.


CONCLUSIONS
A regional budget is suitable for bringing about fundamental changes in terms of content and structure in psychiatric care. The result is clearly improved flexibility as compared to previous care structures; incentives for disorders are reduced. The principle "outpatient before inpatient" is strengthened. The financial plan can be transposed onto other regions, whereby modifications according to the structure of the care region seem necessary.
Deister
Arno
A
Klinikum Itzehoe, Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Itzehoe. a.deister@kh-itzehoe.de
Zeichner
Dirk
D
Witt
Thorsten
T
Forster
Hans-Jürgen
HJ
D001509:Bed Occupancy / Q000191:economics / Q000706:statistics & numerical data; D002017:Budgets / Q000706:statistics & numerical data* / Q000639:trends; D003156:Community Mental Health Services / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D003363:Cost Control / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D005380:Financing, Government / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D005858:Germany; D015276:Health Care Rationing / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D010865:Pilot Projects; D011613:Psychotherapy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D011785:Quality Assurance, Health Care / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D012041:Regional Medical Programs / Q000191:economics* / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D014600:Utilization Review / Q000706:statistics & numerical data