[Economisation of medicine--standards and guidelines: adverse effects and their legal implications]

Evidence-based clinical guidelines are recommendations for physicians and as such only of limited use as binding standards for monitoring the quality of their own achievements. When the Federal Joint Committee translates such guidelines into directives for physicians, hospitals, sickness funds and the insured they must consider the legal quality of such guidelines in order to ensure that physicians may exercise discretion to the extent necessary to providing individual treatment. Evidence-based medical guidelines are suitable means of ensuring quality. They are also intended to guide physicians on the efficiency of their services. But combining clinical guidelines as disease profiles of DMPs with the risk adjustment system of sickness funds or an instrument of selective contracts between sickness funds and physicians carries the risk of excessive bureaucracy and limiting the clinical freedom of physicians.