Provision of outpatient specialist care for mental disorders : Minor regional differences in treatment needs, major regional differences in availability

• Published in: Nervenarzt 2016-11, Vol.87 (11), p.1211-1221
• Main Authors: Jacobi, F, Becker, M, Bretschneider, J, Müllender, S, Thom, J, Hapke, U, Maier, W
• Format: Article
• Language: ger
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care - utilization; Female; Germany - epidemiology; Health Care Rationing - utilization; Health Services Accessibility; Health Services Needs and Demand - statistics & numerical data; Healthcare Disparities - utilization; Humans; Male; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Disorders - therapy; Middle Aged; Prevalence; Psychotherapy - statistics & numerical data; Referral and Consultation - utilization; Young Adult
• ISSN: 1433-0407
• DOI: 10.1007/s00115-016-0147-4

Due to the high burden attributed to mental disorders, an important purpose of a general healthcare system is to provide comprehensive medical specialist care that is both locally available and in line with demand; however, the density of outpatient physicians and psychotherapists significantly varies between regions in Germany. To verify if these variations reflect regional variations of morbidity rates, routine data of statutory health insurance companies are analyzed on a regular basis. But these administrative data directly depend on the actual regional health care supply. Hence, independent epidemiological data on prevalence rates of mental disorders could be a valuable supplement. Analyses are based on prevalence rates of the representative epidemiological German health interview and examination survey and its mental health module (DEGS1-MH) as well as supplemental data from the German national and regional associations of statutory health insurance physicians. The associations between prevalence rates and density of outpatient physicians and psychotherapists were computed for the DEGS sample points, representing 139 different German districts. Transregional care provision for neighboring regions was taken into account. There were neither significant associations of regional density of outpatient physicians and psychotherapists with prevalence rates of mental disorders in general nor with prevalence rates of severe mental disorders; however, taking into account transregional care provision for neighboring regions the huge variability of provider density decreases. The regional inequality of physician and psychotherapist density cannot be explained by regional differences in treatment needs. The results indicate potential improvements in healthcare provision for mental disorders in Germany through the adaptation to actual morbidity rates; however, the definition of treatment needs in mental disorders requires further evaluation.