[Diagnosis related groups (DRG) in child and adolescent psychiatry: results of a prospective pilot study]

Germany faces one of the biggest 'revolutions' in the health care system. As decided by the government in cooperation with medical boards and insurances, beginning with January 1st, 2003 all inpatient treatments will be paid on the basis of adapted Australian-Refined Diagnosis Related Groups. To date, hospitals are requested to obtain prospective databases in order to cluster homogeneous diagnostic groups and calculate realistic treatment-costs. Both psychiatry and child and adolescent psychiatry are so far excluded from the introduction of DRGs. However, most experts predict extensive shifts of patients into psychiatry (i.e. with comorbid internal diseases) under the pressure of short treatments in all non-psychiatric disciplines. Therefore, changes in the payment of psychiatric treatments are inevitably. As part of the DRG pilot-study, we created a catalogue adapted to child and adolescent psychiatry, which was used for 102 consecutively treated inpatients of a child and adolescent hospital. A total of 17.019 prospectively assessed procedures were obtained. Under clinical aspects, 11 categories of 'typical' disorders were analysed. Worst predictability of treatment costs was found for obsessive-compulsive disorders, personality disorders, and eating disorders. Comorbidity and complexity of the disorder was not related to the length of hospital treatment. Implications on future payment systems in child and adolescent psychiatry are discussed.