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Amerschläger points out that interdisciplinary treatment in mental disorders is difficult primarily because of a lack of therapeutic resources. Several studies have shown long waiting times for treatment in specialist care (1, 2). The Central Federal Association of Statutory Health Insurance Funds presented a position paper on reforming psychotherapy in November 2013, which, among others, includes measures to shorten waiting times for treatment (3). In Mecklenburg-Western Pomerania and Saarland, an approach of “urgent referral” has become established, which enables GPs to refer patients to specialist medical care within a few days.

Beckermann criticizes the fact that data collected for billing purposes do not tell us anything about the “true” prevalence of mental disorders. In our article we consistently used the term “prevalence of use” of outpatient, inpatient, and rehabilitational care.

Furthermore, Beckermann points out that healthcare services are legitimized by diagnoses. This is correct in as far as only the existence of a diagnosis will trigger reimbursement by the statutory health insurance funds. Whether longer consultations are billed as “psycho codes”, as she explains, seems questionable in our opinion—medical advice is included in the catalogue of services provided by statutory health insurance physicians. We cannot follow Beckermann’s assertion that diagnoses become “currency.” The “currencies” are, depending on the healthcare area, diagnosis-related groups, flat rates, and fee tariffs—supported by diagnoses, but the amount that is reimbursed is not determined by a diagnosis alone. With regard to the question of which types of diagnoses were included in our study: we included only those diagnoses that were coded as confirmed (“G”). The question of stigmatization as a result of a diagnosis of a mental disorder is certainly a problem—we do not think, however, that it is appropriate to circumvent putting patients at a perceived or actual disadvantage by means of blurred diagnoses or diagnoses that avoid the issue, because this can also result in the withholding of necessary services. Sielk and colleagues found for depression, for example, that psychological stress is often identified and treated in general practices without a corresponding diagnosis being made (4). We cannot follow in such poignancy Beckermann’s claim, that the situation around diagnoses is “indefensible.” New studies of the quality of diagnoses would be needed to confirm such a claim. The fact that, as Beckermann reminds us, diagnoses should be coded only once sufficient certainty has been reached is undisputed—for this reason, suspected diagnoses are explicitly coded “V” in Germany. Both letters to the editor point to several serious deficits in healthcare services for people with mental disorders. But they also underline the importance of health services research with routine data—the quality of which is in need of further improvement.

DOI: 10.3238/arztebl.2014.0271c

On behalf of the authors:

Prof. Dr. med. Wolfgang Gaebel

Klinik und Poliklinik für Psychiatrie und Psychotherapie

Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf

LVR-Klinikum Düsseldorf

wolfgang.gaebel@uni-duesseldorf.de

Conflict of interest statement

Prof. Gaebel is a faculty member of the Lundbeck International Neuroscience Foundation (Scientific Advisory Board). He has received reimbursement of travel expenses from the DGPPN, the AQUA-Institut, and the Federal Working Group of Psychiatric Hospital Operators (Bundesarbeitsgemeinschaft der Träger psychiatrischer Krankenhäuser). He has received event sponsorship (symposium support) from Lilly, Servier, and Janssen Cilag.

1.
Bundes­psycho­therapeuten­kammer. BPtK-Studie zu Wartezeiten in der ambulanten psychotherapeutischen Versorgung. Berlin, 2011. www.bptk.de/fileadmin/user_upload/Publikationen/BPtK-Studien/belastung_moderne_arbeitswelt/Wartezeiten_in_der_Psychotherapie/20110622_BPtK-Studie_Langfassung_Wartezeiten-in-der-Psychotherapie.pdf (last accessed on 27 February 2014).
2.
Kruse J, Herzog W: Zwischenbericht zum Gutachten
„Zur ambulanten psychosomatischen/psychotherapeutischen Versorgung in der kassenärztlichen Versorgung in Deutschland – Formen der Versorgung und ihre Effizienz“. Gießen, 2012. http://s255669059.online.de/pdf/Gutachten_Psychosomatik_Zwischenbericht.pdf (last accessed on 30 January 2014).
3.
GKV Spitzenverband. Reform des Angebots an ambulanter Psychotherapie – Vorschläge der gesetzlichen Krankenkassen (Positionspapier). Berlin, 2013. www.gkv-spitzenverband.de/media/dokumente/presse/publikationen/Positionspapier_GKV-SV_Ambulante_Psychotherapie.pdf (last accessed 31 January 2014).
4.
Sielk M, Altiner A, Janssen B, Becker N, de Pilars MP, Abholz HH: Prävalenz und Diagnostik depressiver Störungen in der Allgemeinarztpraxis. Ein kritischer Vergleich zwischen PHQ-D und hausärztlicher Einschätzung. Psychiatr Prax 2009; 36: 169–74 CrossRef MEDLINE
5.
Gaebel W, Kowitz S, Fritze J, Zielasek J; Use of health care services by people with mental illness—secondary data from three statutory health insurers and the German statutory pension insurance scheme. Dtsch Arztebl Int 2013; 110: 799–808 VOLLTEXT
1.Bundes­psycho­therapeuten­kammer. BPtK-Studie zu Wartezeiten in der ambulanten psychotherapeutischen Versorgung. Berlin, 2011. www.bptk.de/fileadmin/user_upload/Publikationen/BPtK-Studien/belastung_moderne_arbeitswelt/Wartezeiten_in_der_Psychotherapie/20110622_BPtK-Studie_Langfassung_Wartezeiten-in-der-Psychotherapie.pdf (last accessed on 27 February 2014).
2.Kruse J, Herzog W: Zwischenbericht zum Gutachten
„Zur ambulanten psychosomatischen/psychotherapeutischen Versorgung in der kassenärztlichen Versorgung in Deutschland – Formen der Versorgung und ihre Effizienz“. Gießen, 2012. http://s255669059.online.de/pdf/Gutachten_Psychosomatik_Zwischenbericht.pdf (last accessed on 30 January 2014).
3.GKV Spitzenverband. Reform des Angebots an ambulanter Psychotherapie – Vorschläge der gesetzlichen Krankenkassen (Positionspapier). Berlin, 2013. www.gkv-spitzenverband.de/media/dokumente/presse/publikationen/Positionspapier_GKV-SV_Ambulante_Psychotherapie.pdf (last accessed 31 January 2014).
4.Sielk M, Altiner A, Janssen B, Becker N, de Pilars MP, Abholz HH: Prävalenz und Diagnostik depressiver Störungen in der Allgemeinarztpraxis. Ein kritischer Vergleich zwischen PHQ-D und hausärztlicher Einschätzung. Psychiatr Prax 2009; 36: 169–74 CrossRef MEDLINE
5.Gaebel W, Kowitz S, Fritze J, Zielasek J; Use of health care services by people with mental illness—secondary data from three statutory health insurers and the German statutory pension insurance scheme. Dtsch Arztebl Int 2013; 110: 799–808 VOLLTEXT

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