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[Health care contract, economic options and budgeting in ambulatory care]
1Kassenärztliche Bundesvereinigung, Köln. mrichter-reichhelm@kbv.de
Insights
Budgetary constraints in healthcare systems compromise medical quality and progress. Doctors face challenges providing satisfactory care under economic criteria, leading to rationing and potential payment exclusions.
Area of Science:
- Health economics
- Medical policy
Context:
- Analysis of the principle of profitability in medical practice.
- Critique of healthcare systems operating under strict economic criteria.
Purpose:
- To analyze the impact of profitability principles on medical actions.
- To evaluate the effectiveness and consequences of various budgetary instruments in healthcare.
Summary:
- The principle of profitability (sufficient, suitable, economical, necessary) negatively affects medical actions.
- Budgeted systems under economic criteria lead to rationing, reduced quality, and limited medical progress.
- Critique of profitability examinations, guidelines, and department budgets; rejection of restrictive medication and curative budgets due to risks of payment exclusions and quality compromise.
Impact:
- Highlights the detrimental effects of economic constraints on healthcare quality and innovation.
- Suggests alternative models like standard values with individual examination to ensure high-quality patient care.
- Informs policy discussions on healthcare financing and resource allocation.
Abstract:
At the beginning the principle of profitability (sufficient, suitable, economical, necessary) and its effects on medical action are analysed. An explanation is given why the appointed doctors cannot provide medical care satisfactorily in a budgeted system under mere economical criteria. The budget leads to rationing and quality reduction and leaves no scope for medical progress. The instruments for the observance of profitability (profitability examination and guidelines) are dealt with critically. Another instrument, the department budgets, which were introduced by the Social Democrat--Green government, is rejected as a mere economically calculated control mechanism with regard to health care. As a further budget the restrictive medication and curative budgets are presented. They involve the danger of payment exclusions, whereby the high quality care is called into question, if the doctor does not want to suffer a loss of fees. Alternatively, standard values with individual examination are suggested instead of the budgets with collective regress.
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