[Integrated Health Care in cardiology: substitution or addition of new tools?]. / Integrierte Versorgung in der Kardiologie: Additiv oder substitutiv?

On the basis of broad statistical information about procedures and operations in German cardiology, the author discusses probable and already evident effects of emerging Integrated Health Care projects. Among those expectations, possibly a new group of services will emerge that adds rather than substitutes already existing services. By this effect no cost-containment, which is one of the legislative purposes for Integrated Health Care, will be achievable. Besides this pessimistic view, Integrated Health Care in cardiology has the potential to allocate financial funds in a more appropriate way than it is presently usual. For example, procedures that can be performed in outpatients, no longer need to be performed on inpatients for the only reason that hospitals are not entitled to do outpatient services.

Quality assurance in hospitals following the Health Reform Law of the Federal Republic of Germany.

Since January 1, 1989, hospitals licensed in accordance with section 108 of the Social Legal Code, Statute Book V (SGB V) as well as the prevention or rehabilitation facilities under contract in accordance with section 111 SGB V are obliged to participate in quality assurance measures. According to the statement of reasons in the government draft of the Health Reform Law, "quality management in the hospital as well as in the prevention or rehabilitation facilities must ensure high-quality and economic provision of medical services". Quality assurance of medical services in the hospital is intended to disclose professional, structural, and organizational deficits, and thus to create the prerequisites for their elimination. It is not primarily intended to serve as a basis for questions of economy in the hospital. Nonetheless, demands for quality management (above all on the part of the health insurance funds) will also increase continuously for this reason under the pressure of the constantly increasing costs of hospital care. Medical associations and the specialist scientific societies are therefore called on to ensure that not only economic and technical quality are primarily considered, but that the quality of professionally and technically qualified medical action is secured by qualified and convincing contributions to quality assurance.