[Kick-off article: Patients first in health care: Status quo]

"Putting patients first in health care" seems to be a rhetorical statement. But is it really the case that patients always come first? And where exactly do we stand with patient involvement and patient orientation in Germany? What participation options are currently available? Is the patient involvement and patient orientation we have so far achieved sufficient? What needs to be done? These questions will be addressed in the following discussion. Patient self-help organizations, patient interest groups, patient representatives as well as the industrial and political decision-making bodies agree that the patient perspective should be more strongly integrated into health care and health care delivery decisions. The relevant information and sources of evidence, however, are yet insufficiently provided and used. Patients are experts for their own cause. There is consensus that patient participation is and must be an integral part of all levels of health care. Patient representation has made enormous progress in the last decade. This article outlines the current state of affairs of patient representation, patient involvement, their legal legitimacy and possible future scenarios. The transformation from of a paternalistically oriented health care system towards a patient-oriented system is far advanced, but much remains to be done. (As supplied by guesteditors).