Use of health care services by people with mental illness: secondary data from three statutory health insurers and the German Statutory Pension Insurance Scheme.

Facing the current challenges in the care of patients with mental illness requires reliable data on their health care. The problems to be addressed include not only increased use of health care services, incapacity for work, and early retirement due to mental disorders (1, 2), but also the lack of specialized physicians with associated long waiting times, the further development required in intersectoral and interdisciplinary care, and the implementation of new care structures and new compensation systems. Germany’s health care system is very complex. Studies of care provided often include only individual sectors such as outpatient care (3). There are essentially two representative research works available on the prevalence and care of mental illness in Germany: the 1998 German National Health Interview and Examination Survey (4) and a European study (5). The research presented here was the first to bring together secondary data from three insurers (DAK-Gesundheit, KKH-Kaufmannische Krankenkasse [formerly KKH-Allianz], and hkk-erste Gesundheit) and the German statutory pension insurance scheme over a three-year study period (2005 to 2007), forming a dataset that includes almost 3.3 million insurance holders with mental illness. This dataset differs from the German National Health Interview and Examination Survey (1998) in its use of routine data, sample size, and longitudinal design. This makes it possible to assess health care service use objectively and representatively on the basis of rehabilitation and benefit payments. This article presents the prevalence of use of outpatient, inpatient, and rehabilitational care services by those with mental illnesses (ICD-10, F0 to F5) during the study period of 2005 to 2007. For example, for serious depressive illnesses analysis examined the specialties and sectors of care used. This study aims to identify any shortcomings, such as problems at the interface of different sectors of care, and areas in which the care of mental illness might be optimized, through interdisciplinary and intersectoral analyses of the care pathway.