[Changes in mental health care by a regional budget--results of a pilot project in schleswig-holstein (Germany)].

OBJECTIVES: In a region of Schleswig-Holstein, a regional budget was used to investigate which structural changes could be brought about by a financial plan which enables (clinical) treatment that defies rigid financial limits and makes flexible treatment in various settings possible.
METHODS: Since 2003 in a region in Schleswig-Holstein (Steinburg) a financing system has been tested in cooperation with all health insurances. It is no longer based on days of treatment or individual treated cases, instead a budget has been made available for the setting of interdisciplinary psychiatric and pyschotherapeutic management.
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 may be necessary. © Georg Thieme Verlag KG Stuttgart · New York.