[Which wards or hospital departments admit mentally ill patients? An analysis of hospital admissions recorded by the German Statutory Sickness Insurance Body in the light of the introduction of German budgeting practice].

STUDY
OBJECTIVE: As from 2004, a diagnosis-related group financing system will be introduced in all somatic departments and wards in Germany. In future, only psychiatric and psychosomatic departments will continue the system of patient-related per capita budgeting. In view of this fact, it is necessary to determine which hospital wards or departments admit mentally ill patients, as the funding--and hence the therapeutic options available--will vary fundamentally between psychiatric and somatic departments.
METHOD: An evaluation was made of more than 1,000,000 hospitalised patients on the books of the country's second largest medical insurance organization, the DAK, in the year 2001. Of these cases, almost 68,000 were in the diagnostic category F (psychiatric diagnoses) ICD-10.
FINDINGS: Some 32.4 % of cases where the main diagnosis upon dismissal was psychiatric were admitted to somatic wards, most of them (19.3 % of the total) to internal medicine wards. A comparison between the different Federal States of Germany showed that the practice of admitting a substantial proportion of psychiatric diagnoses to somatic wards was not a merely regional problem, but widespread throughout the country. A disproportionately large number of those in somatic wards, mainly internal medicine wards, were in the diagnostic categories F13 (medication dependency), F10 (alcohol-related), F0-09 (cerebral organic disorders) and F40-48 (neurotic disorders). As a rule, the duration of hospital stay on somatic wards was less than half as long as on psychiatric wards. Two thirds of the internal medicine departments that dismissed patients with psychiatric diagnoses were in general hospitals that did not have their own psychiatric department. On the internal medicine wards the second most common diagnostic group in the age group 16-64 years, after ischaemic heart disease (I25), was alcohol-related disorders (F10).
CONCLUSIONS: On the basis of these findings one could expect to find "mixed funding" of specific types of psychiatric diagnosis upon the introduction of the German budgeting practice system, although as a rule this will probably apply mainly to internal medicine departments with psychiatric budgets. As this system encourages shorter periods of hospitalization it seems likely that some of these patients will be transferred to psychiatric/psychosomatic wards after just a few days. However, it appears unlikely that there will be a corresponding increase in the number of psychiatric beds. For this reason, it is important that provision be made to accommodate psychiatric cases elsewhere, preferably in somatic, mainly internal medicine, wards. This expansion of capacity should also include the extension of activities carried out by the psychiatric/psychosomatic counselling and liaison services, as well as the introduction of short crisis intervention techniques and the so-called qualified detoxification of alcohol-abuse patients on internal medicine wards. As the present system offers no incentive to general hospitals to take such measures we can expect demand for beds in psychiatric/psychosomatic hospitals to increase. Furthermore, it is probable that there will also be an increase in the number of re-admissions of such patients, especially alcoholics, to somatic wards.