[The limits of economic efficiency--medication provision and "border violations" through structures and interests]

Overuse, underuse and misuse is still present in the drug provision for insured people covered by the statutory sickness funds. Beside these findings in drug utilisation characteristics the drug market offers a lot of possibilities to improve the efficiency by a better choice of useful drugs, to avoid drug analogues without additional therapeutic value and to replace expensive 'original products' by generic drugs of equivalent efficacy. But the marketing strategies and the industry dependent and often misleading drug information of the pharmaceutical companies anticipate a more efficient drug choice. Therefore it was more than necessary to establish the Institute for Quality and Efficiency in the German Health Care system to evaluate the value of new or very often prescribed drugs. The coming cost-effectiveness appraisal will help to improve patient-orientated value and efficiency of drug therapy.