Features of regional mandatory psychiatric care in Germany

The regional mandatory care is a central element of psychiatric treatment in Germany. Therefore, it is possible to realize care near to the place of residence of psychiatric patients and good contact to the outpatient health system. Up to now the new payment system in psychiatry in Germany does not explicitly include this central factor. The article investigates which criteria possibly describe psychiatric mandatory care and whether they can be ascertained from routine data. The results are based on the so-called A A 21 records of 47 psychiatric and psychosomatic clinics all of which participated in the German VIPP (healthcare indicators in psychiatry and psychosomatics) project. It is obligatory to send the standardized A A 21 record to the Institute for the Hospital Remuneration System (InEK) annually. The study identified two factors which could describe clinics with regional mandatory care. Many patients attend these hospitals outside the core time of Monday to Friday, 8 am to 5 pm and the distance to their place of residence is shorter. This is associated with a higher day-related valuation, the so-called day mix index (DMI). Routine data contain information describing regional mandatory psychiatric care. Patients treated in this system show a higher DMI. This means higher proceeds for the hospitals but it is not clear if these proceeds are able to cover the higher costs in clinics with regional mandatory care. Therefore, it is necessary for the InEK to set up a new cost center for all clinics which participate as a so-called calculation site. By posting all structural costs of mandatory care in this cost center it will be possible to compare them with the income of psychiatric clinics in the future.