The development of quality assurance in the German health care system

Quality assurance efforts in the German health care system have primarily been a responsibility of the medical profession. The Federal and State Physician Chambers coordinated early quality assurance studies, which conformed to the guidelines of voluntary participation by physicians, confidentiality of data, and no imposition of sanctions for poor performance. These guidelines were challenged by the Health Reform Act of 1989, which made the legal regulations for quality assurance the same for hospitals as for out-patient care. Some current draft implementation plans conform to the principle of anonymity, requiring no disclosure of patient-specific, physician-specific, or hospital-specific data to third parties; others allow release of data to individual insurers or their associations. Although no consensus has been reached as to how quality assurance will be performed in the future in Germany, it will clearly become an integral part of the system.