[Radiology, health care structural reform and health system research--status, developments and challenges]

Through the health care reform act of 1993 and the next reform step currently under discussion, the financing mechanisms of both the ambulatory and the hospital sector of the German health care system will be changed drastically which will effect radiology earlier and more than other specialties. In the ambulatory care sector, fee-for-service has led to the tendency of more services, especially through self-referral to diagnostic imaging. Currently, managed care structures are under discussion which will lead to fewer services. In the hospital sector, reimbursement of all costs on a per-diem basis also had the effect of much diagnostic imaging. Beginning in 1996, diagnostic-related groups with pre-determined fixed reimbursements will supplement per-diem charges. Internal financial billing will lead to fewer demands for imaging services. Health services research in radiology is necessary to demonstrate the efficacy of imaging procedures at all levels from structure (technical efficacy) through process (clinical efficacy) to outcome (outcome efficacy).