[Solutions to problems in other countries]

The costs of public health in Germany are permanently increasing due to changes in the age-structure of the population, the development of new and expensive methods of medical treatment, the appearance of new diseases and other causes. There is a vivid discussion about how we could rationalize and/or restructure the public health system. In order to find solutions we should consider the provision of public health in other countries, for example in Sweden, Great Britain, the USA and Italy. Sweden has introduced a primary care system and fostered ambulatory care, with general practitioners and specialists working hand in hand in public health centres. In the USA costs have been reduced through the instruments of "Managed Care": global fees, global budgeting in hospital services, avoidance of hospitalization and efficiency checks. In Great Britain, medical care is centralized in the "National Health Service", which is paid out of the tax revenue. In Italy, there are local primary care centres, and secondary care is provided only on referral by a primary care physician. For drugs, a positive list has been introduced. Some of the instruments referred to could be implemented in Germany and help economize the provision of public health. However, the liberties of doctors and patients would probably be restricted.