König Hans-Helmut, Heinrich Sven, Heider Dirk, Deister Arno, Zeichner Dirk, Birker Thomas, Hierholzer Cornelia, Angermeyer Matthias C, Roick Christiane
Universität Leipzig, Professur für Gesundheitsökonomie, Klinik und Poliklinik für Psychiatrie.
Psychiatr Prax. 2010 Jan;37(1):34-42. doi: 10.1055/s-0029-1223418. Epub 2010 Jan 13.
To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) on costs and effectiveness of care.
Patients with a diagnosis according to ICD-10 F10, F2 or F3 were interviewed in the model region (MR, n = 258) and a control region (CR, n = 244) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HoNOS, SCL-90R, PANSS, BRMAS / BRMES), functioning (GAF, SOFAS) and quality of life (WHOQOL-BREF, EQ-5D). Use of care was determined semi-annually.
There were no significant differences in the development of psychopathology and quality of life between MR and CR. In the MR, functioning of patients with schizophrenia and affective disorders improved significantly more strongly. The development of total mental health care costs was not different between MR and CR. However, the costs of office based mental health care increased slightly more strongly in the MR, indicating a small cost-shift from the RPB to extrabudgetary financed services.
The RPB showed slight advantages regarding the effectiveness of care and did not significantly change the total mental health care costs.
分析精神科护理的按人头多部门融资模式（RPB）对护理成本和效果的影响。
在按照按服务收费原则融资的模式地区（MR，n = 258）和对照地区（CR，n = 244）对根据国际疾病分类第十版（ICD - 10）F10、F2或F3诊断的患者进行访谈。在基线、随访1.5年和3.5年时，使用精神病理学指标（临床总体印象量表 - 严重程度[CGI - S]、健康需求和问题量表[HoNOS]、症状自评量表90修订版[SCL - 90R]、阳性和阴性症状量表[PANSS]、简明躁狂评定量表/简明抑郁评定量表[BRMAS / BRMES]）、功能指标（大体功能评定量表[GAF]、社会功能大体评定量表[SOFAS]）和生活质量指标（世界卫生组织生活质量简表[WHOQOL - BREF]、欧洲五维度健康量表[EQ - 5D]）对患者进行访谈。每半年确定一次护理使用情况。
MR和CR在精神病理学发展和生活质量方面无显著差异。在MR中，精神分裂症和情感障碍患者的功能改善更为显著。MR和CR之间的精神卫生保健总费用发展情况没有差异。然而，MR中基于门诊的精神卫生保健费用增长略多，表明存在从RPB到预算外融资服务的小成本转移。
RPB在护理效果方面显示出轻微优势，且未显著改变精神卫生保健总费用。
