Where is convergence of psychiatry budgets leading to? A comparison of staffing regulations and actual personnel resources

Abstract

Staffing regulations have determined the number of qualified staff required for sufficient, appropriate and economical inpatient mental health care in Germany since 1991. This minimum level of structural quality will probably be abolished in the context of the convergence of hospital budgets starting in 2019. The aim of this study was to analyze the current fulfilment of staffing regulations in terms of time per patient in a large nationwide sample. The required minutes of staff time as defined by staffing regulations were calculated for each patient using the treatment classifications provided by a large nationwide database. The actual use of staff time was calculated on the basis of average costs published by the German Institute for Hospital Reimbursement. Both figures were compared to calculate the fulfilment of staffing regulations. The study included approximately 95,000 inpatient episodes from 46 psychiatric hospitals and departments with a total length of stay of almost 2.5 million days. On average, the weekly use of staff resources per patient was 190min (10 %) below the requirements of the staffing regulations. The largest gap in absolute terms was found in nursing staff where the weekly time per patient was 189min (14 %) below the requirements of the staffing regulations. The convergence of psychiatric hospital budgets starts in 2019 below a level of funding required to fulfil staffing regulations. This would perpetuate inadequately funded structures and should initially be opposed with a demand for complete fulfilment of staffing regulations. Thereafter, a normative consent should be reached to define the resources required for current inpatient mental health care.