The new financial compensation system PEPP: an ethical analysis

• Published in: Nervenarzt 2014-11, Vol.85 (11), p.1410-1418
• Main Author: Vollmann, J
• Format: Article
• Language: ger
• Subjects: Ethical Analysis - methods; Germany; Humans; Mental Disorders - economics; Mental Disorders - psychology; Physician-Patient Relations - ethics; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - ethics; Psychiatry - economics; Psychiatry - ethics; Reimbursement Mechanisms - economics; Reimbursement Mechanisms - ethics
• ISSN: 1433-0407
• DOI: 10.1007/s00115-014-4019-5

The new compensation system for psychiatric and psychosomatic institutions (German acronym: PEPP) not only constitutes a change in billing practices, but also necessitates an ethical investigation and analysis of possible consequences of the new legislation for those affected in practice. Following the presentation of the new PEPP and its consequences for psychiatric practice, problems and areas of conflict will be analyzed from an ethical perspective and discussed. Ethical conflicts exist in the following areas: (1) in the attempt to standardize inpatient care and invoicing for mental illnesses, (2) in poorer treatment for severely ill patients in view of degressive per diem rates, (3) in false incentives due to threshold values e.g. for 1:1 health professional-patient ratios in the case of coercive measures and (4) due to the inappropriate use of a supposed normative neutral quantitative economic model for a qualitative work area that often takes place in human border zones such as complex inpatient care of severely mentally ill patients. The ethical analysis of PEPP reveals that apart from the limited opportunities to improve efficiency, there is a considerable ethical risk of loss of quality in psychiatric inpatient care in particular for severely and chronically mentally ill patients.