Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Dec 2000
["Medical decision making in the tension field between medical possibilities, cost pressure and humanity."].
The progress in medicine has contributed to the fact that for 50 years life expectancy in Germany has increased by three to four years per decade. The number of older people has considerably increased and at the same time there has been a decline in the birthrate with the effect that the portion of the people over 60 years, now a quarter of the population, will rise to a third of the population in 2040. The dual relationship between patient and physician has changed due to the extension of the statutory health insurance to more than 90% of the population. ⋯ Thus the financial, organizational and structural deficits in the health care system that are resulting from the social legislation are shifted by means of the liability law to the individual physician or to other service providers. Even treatment guidelines cannot protect them from this because the "standard patient" does not exist. What we really need are appropriate reforms including adjustments of the insurance structures which offer the insured alternatives: Expansion of the financial elements of the statutory health insurance Adjustments of the health care structures with integration between the outpatient and inpatient sector Restriction of the legislator to the definition of framework provisions and service limits Orientation of the health care necessities to the health care needs of the patients Economy must not dominate over humanity Adjustment of the social legislation and the liability law Settlement of the details by the joint self-administration of physicians and health insurance funds.