Use of health care services by people with mental illness: secondary data from three statutory health insurers and the German Statutory Pension Insurance Scheme

Abstract

Background: A discipline- and sector-specific analysis of health-care utilization by persons with mental illness in Germany is an indispensable aid to planning for the provision of adequate basic care.

Method: Secondary data from three statutory health insurers and the German Statutory Pension Insurance Scheme for the period 2005-2007 were evaluated to identify insurees with mental illness (ICD-10 diagnosis groups F0-F5).

Results: In the period 2005-2007, 3.28 million (33%) of 9.92 million insurees had at least one contact with the health-care system in which a mental disorder was diagnosed. 50.4% (1,651,367) of these insurees had at least two mental disorders. Nearly all (98.8%) of the insurees with a psychiatric index diagnosis had at least one somatic diagnosis coded as well. 95.7% of treatments were provided in the outpatient setting. Somatic medical specialties provided the majority of treatments both in ambulatory care and in the hospital. For example, 77.5% of persons with severe depression were treated with five kinds of treatment that were provided exclusively by primary care physicians and other specialists in somatic medicine in private practice, sometimes in combination with psychiatric treatment or psychotherapy.

Conclusion: There was a high degree of comorbidity of mental and somatic illness. The fact that the vast majority of treatment was provided in the outpatient setting implies that cooperation across health-care sectors and disciplines should be reinforced, and that measures should be taken to ensure the adequate delivery of basic psychiatric care by primary care physicians.

Figure 1

Distribution of diagnoses 2005 to 2007: Insurance holders per diagnosis group. All insurance holders diagnosed with a mental disorder (F0 to F5) during the study period, 2005 to 2007 (n = 3 275 399). F0: Organic, including symptomatic mental illnesses F1: Mental and behavioral disorders caused by psychotropic substances F2: Schizophrenia, schizotypal, and delusional disorders F3: Affective disorders F4: Neurotic, stress, and somatoform disorders F5: Behavioral abnormalities with physical disorders and factors.

Figure 2

Outpatient care (2005 to 2007) by discipline and diagnosis (F0 to F5). All insurance holders receiving outpatient treatment and diagnosed with a mental illness (N = 3 197 632, corresponding to 97.6% of all patients diagnosed with a mental illness). F0: Organic, including symptomatic mental illnesses F1: Mental and behavioral disorders caused by psychotropic substances F2: Schizophrenia, schizotypal, and delusional disorders F3: Affective disorders F4: Neurotic, stress, and somatoform disorders F5: Behavioral abnormalities with physical disorders and factors.

Figure 3

Percentages of care provided in inpatient and day-patient facilities for patients with a main diagnosis of mental illness during the study period, 2005 to 2007, by department type. All insurance holders receiving inpatient treatment for a main diagnosis of a mental illness F0 to F5 (N = 192 981). Multiple cases for a single individual permitted (individuals with multiple inpatient stays, possibly in multiple departments). F0: Organic, including symptomatic mental illnesses F1: Mental and behavioral disorders caused by psychotropic substances F2: Schizophrenia, schizotypal, and delusional disorders F3: Affective disorders F4: Neurotic, stress, and somatoform disorders F5: Behavioral abnormalities with physical disorders and factors. Mental comorbidity: multiple simultaneous or consecutive psychiatric diagnoses. ^*Treatment in addiction/geriatric psychiatry is included in general psychiatric departments

Figure 4

Pathways of health care during the study period 2005 to 2007 for those with an index diagnosis of severe depression in the first quarter of 2005 (ICD-10-GM: F32.2/F32.3/F33.2/F33.3) (n = 26 412). There were 524 different care pathways. The five most common pathway types are described in greater detail in decreasing order of frequency. ^*Median time in sector of care, days (with no treatment in another sector of care in the intervening period; time from first to last day of treatment)

eFIGURE

Care pathways during the study period 2006 to 2007 for those with an index diagnosis of severe depression (ICD-10-GM: F32.2/F32.3/F33.2/F33.3) in the first quarter of 2006 (with no diagnosis of depression of any severity or any other mental illness during the preobservation period, 1 January to 31 December 2005; n = 1149). There were 89 different care pathways. The five most common pathway types are described in greater detail in decreasing order of frequency. ^*Median time in sector of care, days (with no treatment in another sector of care in the intervening period; time from first to last day of treatment)