title: [System-immanent incentives in the remuneration for psychiatry and psychosomatics : Analysis exemplified by treatment of alcohol-related disorders].
abstract: BACKGROUND
  The German fixed rate remuneration system in psychiatry and psychosomatics (PEPP) has been criticized by many specialty associations because negative effects on mental healthcare are expected through economic incentives.
  
  
  OBJECTIVE
  Through analysis of performance data in the treatment of alcohol dependency at the Evangelical Hospital Bielefeld (Evangelisches Krankenhaus Bielefeld, EvKB) from 2014 and various simulations, the incentives of the PEPP (version 2015) were analyzed and its potential impact on patient care was evaluated.
  
  
  METHODS
  Groups of cases were created based on the clinical data. Various parameters were evaluated, such as duration of treatment, PEPP coding, loss of income by merging cases and case remuneration. Additionally, changes in the duration of treatment, the intensity of treatment and the intensity of care were simulated.
  
  
  RESULTS
  In the simulations a reduction in the duration of treatment by 16.1 % led to additional revenues of 1.9 % per treatment day. The calculated additional costs of 1:1 care and intensive nursing care were not completely covered by the additional revenues, whereas psychotherapeutic inpatient treatment programs showed positive profit contributions. Complicated cases with increased merging of cases showed lower revenues but with above average expenditure of efforts.
  
  
  CONCLUSIONS
  The current version of the PEPP leads to misdirected incentives in patient care. This is caused, for example, by the fact that higher profit contributions can be realized in some patient groups and intensive nursing care of patients is insufficiently represented. It is not clear whether these incentives will persist or can be compensated in subsequent versions of the system.
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Remterweg 69/71, 33617, Bielefeld, Deutschland. Hannes_Horter@gmx.de.
authors.forename: H
authors.initials: H
authors.lastname: Horter
authors.affiliation: Fakultät Wirtschafts- und Sozialwissenschaften, Hochschule Osnabrück, Osnabrück, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Zapp
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Remterweg 69/71, 33617, Bielefeld, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Driessen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011570:Psychiatry / Q000191:economics*; D011611:Psychosomatic Medicine / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Alcoholism; Costs and cost analysis; Fixed rate remuneration system; Health care; Patient care