U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N BERLIN 09.07.2005 SOME ASPECTS OF THE ACTUAL SITUATION OF PSYCHOSOMATIC MEDICINE IN GERMANY ULRICH T. EGLE U N I V E R S I T Ä T S K L I N I K U M M A I N Z Sea of grove P S Y C H O S O M A T I S C H E M E D I Z I N diagnostic psychosomatic reefs sheikhdom borderlands laboratory center corner Lake district marshland h e c e p s o f r e v r i / w o f l g n o l E G L E 1
PSYCHOSOMATIC MEDICINE IN GERMANY U N I V E R S I T Ä T S K L I N I K U M M A I N Z FOUR STEPS OF HEALTH CARE P S Y C H O S O M A T I S C H E M E D I Z I N � � Psychosomatic basic competence Psychosomatic basic competence • 60 000 physicians (68% of all gynecologists and 62% of all GPs) • 60 000 physicians (68% of all gynecologists and 62% of all GPs) � � Outpatient psychotherapy Outpatient psychotherapy • • 15 500 psychotherapists 15 500 psychotherapists (3500 are physicians with specialization in (3500 are physicians with specialization in „ „Psychosomatic Medicine Psychosomatic Medicine and Psychotherapy“ “, 12 000 psychologists) , 12 000 psychologists) and Psychotherapy � � Inpatient psychotherapy/psychosomatic medicine Inpatient psychotherapy/psychosomatic medicine • • 3200 beds in 25 university departments and 39 other hospitals 3200 beds in 25 university departments and 39 other hospitals >> 25 000 patients in 2002 (45 days/patient, range: 3 to 12 week >> 25 000 patients in 2002 (45 days/patient, range: 3 to 12 weeks) s) � � Psychosomatic rehabilitation Psychosomatic rehabilitation • 15 500 beds in rehabilitation clinics • 15 500 beds in rehabilitation clinics >> 140 000 patients in 2002 (M=38 days/patient) >> 140 000 patients in 2002 (M=38 days/patient) E G L E BASIC COMPETENCE IN PSYCHOSOMATICS U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N Medical curriculum � Obligatory lecture (24 h) and course (12 h) of psychosomatic medicine for all medical students in the 5th year Continuing education � 20 h lectures on theoretical know-how � 30 h practice of doctor-patient-communication � 30 h Balint group (understanding doctor-patient-relationship) E G L E 2
Mean number of psychotherapeutic sessions of outpatient treatment paid by German health insurances: 78 (2003) U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N E G L E CURRICULUM FOR SPECIALIZATION IN U N I V E R S I T Ä T S K L I N I K U M M A I N Z „PSYCHOSOMATIC MEDICINE AND PSYCHOTHERAPY“ P S Y C H O S O M A T I S C H E M E D I Z I N IN GERMANY 1 year in psychiatry 1 year in psychiatry � � 1 year internal medicine (6 month neurology or 6 month 1 year internal medicine (6 month neurology or 6 month � � gynecology possible) gynecology possible) 3 years psychosomatic medicine 3 years psychosomatic medicine � � � 2 years of inpatient treatment � 1 year of outpatient treatment and CL-service � 150 h of self-experiences � 1500 h of psychotherapeutic sessions with supervision � diagnostic examinations of 150 (?) patients � Alternative between cognitive-behavioral or psychodynamic focus of the curriculum E G L E 3
U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N SPECTRUM OF DISORDERS TREATED IN PSYCHIATRIC HOSPITALS IN GERMANY (Deutsche Angestellten Krankenkasse, 2003). N=22.264 female patients and N=15.474 male patients E G L E DIAGNOSTIC SPECTRUM OF DISORDERS TREATED IN PSYCHIATRIC AND IN PSYCHOSOMATIC DEPARTMENTS U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N Psychosomatik Psychiatrie Referenz-Psychiatrie (Berger 2004) 60 50 40 % 30 20 10 0 F0 F1 F2 F3 F4 F5 F6 F7 Sonstige ICD-10-Erstdiagnosen einer Klinik f� r Psychosomatische Medizin und eine r Klinik f� r Psychiatrie und Psychotherapie an einem Krankenhaus der Maximalversorgung 2003 (im Vergleich die H� ufigkeiten einer Universit� tspsychiatrie [Berger 2004 ] ) Hildenbrand 2005 E G L E 4
Target: 5 bed for psychosomatic inpatient treatment U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N for 100 000 inhabitants > 18 years E G L E SPECTRUM OF DIAGNOSES OF PSYCHOSOMATIC INPATIENT REHABILITATION (2002, N=140 000) U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N E G L E 5
ECONOMIC RESULTS OF PSYCHOSOMATIC INPATIENT TREATMENT U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N (DAK/AHG study, Zielke 2004) � N=338 members of a large German health insurance company (DAK) treated in 3 psychosomatic hospitals with CBT (from 16.1.99 to 22.2.2000) � N=252 with a sick certificate in the past 2 years � wrote off sick on average for 24,5 weeks (median) � 48% because of psychic problems/disorders 27% because of chronic pain � length of the disorder 7,3 years (median) E G L E ECONOMIC RESULTS OF U N I V E R S I T Ä T S K L I N I K U M M A I N Z PSYCHOSOMATIC INPATIENT TREATMENT P S Y C H O S O M A T I S C H E M E D I Z I N (DAK/AHG study, Zielke 2004) Health costs for each case (€) 2 2- -yr before yr before 2 2- -yr after yr after � Health insurance 12 700 6 800 (e.g. costs of out- and inpatient treatments, drugs, sick pay) � Employer 27 100 11 400 (e.g. statutory sick pay, loss of productivity) � Total 39 800 18 200 E G L E 6
ECONOMIC RESULTS OF U N I V E R S I T Ä T S K L I N I K U M M A I N Z PSYCHOSOMATIC INPATIENT TREATMENT P S Y C H O S O M A T I S C H E M E D I Z I N (DAK/AHG study, Zielke 2004) Costs of inpatient treatment Costs of inpatient treatment � Mean length of treatment 51,6 days � Daily rate for inpatient care 110 € each day >> average costs of treatment for each case: € 5676.- >> average costs of treatment for each case: E G L E ECONOMIC RESULTS OF U N I V E R S I T Ä T S K L I N I K U M M A I N Z PSYCHOSOMATIC INPATIENT TREATMENT P S Y C H O S O M A T I S C H E M E D I Z I N (DAK/AHG study, Zielke 2004) cost-benefit-relation reduction of costs for health reduction of costs for health - 21 550 - 21 550 € € � � average costs of treatment 5 680 € € average costs of treatment 5 680 � � 1 : 3,79 E G L E 7
ECONOMIC RESULTS OF U N I V E R S I T Ä T S K L I N I K U M M A I N Z PSYCHOSOMATIC INPATIENT TREATMENT P S Y C H O S O M A T I S C H E M E D I Z I N (DAK/AHG study, Zielke 2004) � Analysis of opportunity calculation considering considering productivity productivity of commercial of commercial employees employees calculation using a using a formula formula from from buissness buissness mangement mangement >> >> Net Net benefit benefit for for each each case case € 48 224.- >> Net benefit of the N=252 patients in the study: > € 12 Mio. E G L E 8
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