[Status and perspectives of quality assurance in socialized medical services]

Quality, quality assurance, and quality management are becoming more and more dominating topics in German public health. Quality is named as the most important goal of medical care in the public health related political discussions of physicians, hospitals, health insurances, and politicians but is affected by differences in political, economical, medical, and particular interests. To avoid a single-sided discussion about questions of quality (only with the goal of increasing efficiency and reducing costs), the society of physicians of Germany and the society of panel physicians published a common stock of 10 theses about medical quality assurance and quality improvement in the spring of 1996: (1) Medical quality assurance and quality improvement serve the patient. (2) Medical quality assurance and quality improvement do not primarily serve the improvement of economic efficiency. (3) Quality assurance programs have to be problem oriented and coordinated; quality in the ambulant and hospital setting cannot be different. (4) The appropriateness of quality assurance programs has to be evaluated firmly. (5) Transparency, communication, and cooperation are prerequisites of a successful quality assurance and quality improvement. (6) Comprehensive internal quality assurance is the foundation of continuous quality improvement. (7) External quality assurance should initiate the development of procedures for internal quality assurance. (8) Quality assurance has a chance for realization only if it is carried by the conviction and the effort of every participant to perform at relatively high quality, to subject his own doing to continuous checks and improvement, and to compare with others. (9) Quality has it's price. (10) Quality assurance and continuous quality improvement are the cornerstones of a quality policy in public health. The current situation and future developments of quality assurance in ambulant health care are discussed in this paper.