title: [Quality assurance from the viewpoint of medical management by health insurance].
abstract: Legal requirements of SGB V make provisions for quality assurance (QA) activities in relation to inpatient and outpatient care. Available contracts between health providers and institutions covering costs presently regulate QA in three distinct areas in surgery: inpatient and outpatient care, Fallpauschale (fee for case) and Sonderentgelte (fee for service), and out-patient surgical treatment. MDK as a medical counselling and review agency working on behalf of health insurance companies has a more or less well defined role in the organization (board membership) and actual work (evaluation and probing) of external QA. Its participation and competence derive from legal authorization (SGB V) and hence from its given assignments: review of indication, economical aspects and quality of services provided--each on a single case basis and on a more general basis, nursing care, hospital budgets and finally planning capacity for hospital care.
authors.affiliation: Krankenhaus-Dezernat, im Medizinischen Dienst der Krankenversicherung Hamburg.
authors.forename: B
authors.initials: B
authors.lastname: Werner
mesh_terms: D003363:Cost Control / Q000331:legislation & jurisprudence; D005245:Fee Schedules / Q000331:legislation & jurisprudence*; D013502:General Surgery / Q000331:legislation & jurisprudence*; D005858:Germany; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000331:legislation & jurisprudence*
vernacular_title: Qualitätssicherung aus Sicht des Medizinischen Dienstes der Krankenversicherung (MDK).