Psychiatric Inpatient Care under Economic Pressure

past few years. In the cost discussion in the psychiatric inpatient setting, length of inpatient stay is of great concern: duration of treatment and cost per case are closely correlated, and costs can be influenced via this indicator because, unlike in somatic medicine, the daily care rates are fixed (1). Within the specialty psychiatry and psychotherapy, the health insurance companies are demanding shorter inpatient stays, especially for patients with addiction disorders (2). A cost effectiveness calculation that makes more sense in terms of health economics over longer time periods and across all treatment sectors does currently not exist (3). In addition, duration of inpatient stay is controversial as a criterion of therapeutic efficiency. When comparing hospitals with regard to length of inpatient stay, several methodological pitfalls have to be borne in mind, especially in the specialty psychiatry and psychotherapy, and different variables have to be considered (5-7). Nationally and internationally, the durations of inpatient stays are decreasing substantially in hospitals for psychiatry and psychotherapy (7, 8). The mean duration of treatment in special hospitals and wards for psychiatry/psychotherapy fell over the years from 40.7 days (1994) to 24.7 days (2004) (9). A reduction of 40% in the length of inpatient stay will have consequences. Internationally, studies into the effects of increasingly shorter inpatient stays in psychiatry and psychotherapy have found an increase in readmission rates (10-14). The cumulative length of inpatient stay was decreasing only partly (13, 14); in patients with addiction disorders (12) and schizophrenia (11) it remained constant. A study conducted in Germany showed that when the length of inpatient stays decreased and readmission rates increased, the cumulative duration of inpatient stay fell significantly in dementia patients, a smaller reduction was seen in patients with schizophrenia and drug addiction disorders, and a rise was seen in patients with alcohol disorders (2). Against this background, we evaluated data from the psychiatric basic documentation system (DGPPN-BADO) to find out whether the rate of