R. Leidl, P. Potthoff, and D. Schwefel Health is a most vital resource represented in the degree of our well-being and our ability to conduct active and satisfactory lives. Acute and chronic illnesses diminish such well-being and abilities and may require resources for medical or nursing care. The improvement in health status, a major objective of health policy, requires the measurement of the severity of diseases and their consequences as essential elements of information. In application, the measurement approaches are gaining in relevance as they become more feasible and as more experience is gathered about their implementation and utilization. The feasibility of these new information tools is supported by developments in data processing technologies that permit broadly based empirical applications. Wider applications lead to improvements in the management use of this information. At the European level, better indicator systems of diseases and their various aspects are facing an increasing demand for patient-based health and health system comparisons and analyses. The measurement of health status and its implications can comprise a number of dimensions: various concepts of health and disease, types of diseases, methodological approaches of measurement, purposes of application and states of implementation.

Since the early 1970s, delivery of care to people who are consid- ered to suffer from chronic psychotic disturbances has been at a crossroads. In 1983, the European Regional Office of the World Health Organization (WHO), within its health economics pro- gramme, encouraged international research on the economic impli- cations of alternative strategies of care for those patients. Origi- nally, it was intended to compare at least two or more strategies of managing chronic psychotics, especially strategies which place dif- ferent emphasis on inpatient and outpatient care. Instead of designing a fully coordinated, multinational, multi- centre study based on a mutually agreed on study protocol, we de- cided on the following: - To meet with researchers interested in the social, psychological, and economic features of health care for chronic psychotic pa- tients - To stimulate ongoing research projects or to initiate new ones - To discuss quite different approaches from international and - terdisciplinary points of view - To review and revise the diversified end products of such an open research process For this purpose, we outlined a broad range of topics which could be included in the study: - Methodological problems of evaluation in this field - Social and economic implications of psychiatric deinstitutiona- zation - Scenarios of various degrees of deinstitutionalization - Assessment of (hospital) costs of the treatment for chronic sc- zophrenic and other psychotic patients - Public and private costs of the main treatment strategies - Time-expenditure analyses of chronic psychotic patients

Variablen ............................................................. 103 Diagnosen ............................................................. 109 Tabellenanhang ....................................................... 115 Literatur .............................................................. 247 Verzeichnis der Abbildungen Abb. 1. Auftretenshaufigkeiten ausgewahlter Diagnosengruppen nach Altersgruppen der Patienten .. . . . . . . . . . . . . . . . . . . .. . . 33 . . . . . . . Abb.2. Haufigkeitsverteilungen der Patienten mit ausgewahlten Diagnosengruppen nach Altersgruppen der Patienten .................................................. 39 Abb.3. Haufigkeitsverteilung der Patienten nach Diagnosenzahl ................................................. 66 Abb. 4. Variablenherkunft .............................................. 104 Verzeichnis der Tabellen im Text Tabelle 1. Scheine nach Scheinart, Behandlungsart, Fachgruppe und Bezirk ..................................... 5 Tabelle 2. Arzte nach Fachgruppe, Scheinzahl in der Stichprobe und Bezirk ................................................. 6 Tabelle 3. Patienten nach Geschlecht, KassenzugehOrigkeit, Versicherten-und Altersgruppen sowie Wohnort . . . . . . . . . . . . . . . 8 Tabelle 4. Patienten nach Alters-und Versichertengruppen .............. 9 Tabelle 5. Patienten nach Behandlungsart .............................. 9 Tabelle 6. Patienten nach Behandlungsart und Anzahl der Scheine (= Anzahl der Arzte) . . . . . . . . . . . . . . . . . . .. . . 10 . . . . . . . . Tabelle 7. Patienten nach Anzahl der Behandlungstage und Geschlecht ............................................. 11 Tabelle 8. Patienten nach Fachgruppe der konsultierten Arzte und nach Geschlecht ............................................ 13 Tabelle 9. Patienten nach Inanspruchnahme von Allgemeinarzten oder Facharzten und nach Alter ....... ......................... 14 Tabelle 10. Patienten nach Inanspruchnahme von Primiir-oder Sekundararzten und nach Alter .............................. 15 Tabelle 11. Patienten nach Scheinart .................................... 16 Tabelle 12. Patienten nach Anzahl und Art der verwendeten Scheine .............................. . . . . . . .. . . 17 Tabelle 13. Patienten nur in kurativer Behandlung und nur mit Uberweisungs-oder Belegarztscheinen nach Patientenmerkmalen ........................................ 18 Tabelle 14. Haufigste Einzelleistungen nach Abrechnungshaufigkeit und Ansatz in Patienten ....................................... . 19 XII Tabelle 15. Patienten nach Inanspruchnahme von Leistungsgruppen ...................................... 19 Tabelle 16. Patienten nach Alter, Geschlecht, Versichertengruppe unct Wohnort sowie nach Kassenzugehorigkeit ..................... 21 Tabelle 17. Patienten nach Inanspruchnahmemerkmalen und Kassenart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 22 . . . . . . . . . . . . . . . Tabelle 18. Patienten nach Inanspruchnahme von Arztgruppen und Kassenart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 23 . . . . . . . . . . . . ."