title: [Rationing in inpatient psychiatric care].
abstract: OBJECTIVE
  This study examined whether and in which services in psychiatric institutions implicit rationing takes place from the perspective of doctors and nurses.
  
  
  METHODS
  From October 2013 to the middle of 2014 we conducted a written and standardized survey among physicians/psychologists (n = 256) and nurses (n = 796) from eight psychiatric hospitals in Germany.
  
  
  RESULTS
  Out of 11 clinical activities 4 judged as necessary, namely communication and interaction with patients and relatives, coordination of treatment with other professionals and adequate documentation of the treatment, were not carried out sufficiently or implicitly rationed by 42-59% of the surveyed physicians/psychologists. Multivariate analysis identified a higher case load, poor relationships with superiors and an overall heavy workload as significant predictors of implicit rationing.
  
  
  CONCLUSIONS
  The services which are particularly necessary for an effective treatment of mentally ill people, i.e. strong patient orientation and close cooperation with other professionals are jeopardized by the implicit rationing.
authors.affiliation: Zentrum für Sozialpolitik (ZeS)/SOCIUM, Universität Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Deutschland. bbraun@zes.uni-bremen.de.
authors.forename: B
authors.initials: B
authors.lastname: Braun
authors.affiliation: BAB Institut für betriebswirtschaftliche und arbeitsorientierte Beratung GmbH Bremen, Bremen, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Brückner-Bozetti
authors.affiliation: Lehrstuhl für Allgemeine Betriebswirtschaftslehre, insbes. Marketing und Handelsbetriebslehre, Philipps‑Universität Marburg, Marburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Lingenfelder
authors.affiliation: Zentrum für Psychiatrie Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I, Universität Ulm, Ulm, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Uhlmann
authors.affiliation: Zentrum für Psychiatrie Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I, Universität Ulm, Ulm, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Steinert
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D005858:Germany; D015276:Health Care Rationing / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team; D011795:Surveys and Questionnaires
keywords: Implicit rationing; Nursing personnel; Physicians/psychologists; Psychiatric treatment; Remuneration system PEPP