title: [Health care contract, economic options and budgeting in ambulatory care].
abstract: At the beginning the principle of profitability (sufficient, suitable, economical, necessary) and its effects on medical action are analysed. An explanation is given why the appointed doctors cannot provide medical care satisfactorily in a budgeted system under mere economical criteria. The budget leads to rationing and quality reduction and leaves no scope for medical progress. The instruments for the observance of profitability (profitability examination and guidelines) are dealt with critically. Another instrument, the department budgets, which were introduced by the Social Democrat--Green government, is rejected as a mere economically calculated control mechanism with regard to health care. As a further budget the restrictive medication and curative budgets are presented. They involve the danger of payment exclusions, whereby the high quality care is called into question, if the doctor does not want to suffer a loss of fees. Alternatively, standard values with individual examination are suggested instead of the budgets with collective regress.
authors.affiliation: Kassenärztliche Bundesvereinigung, Köln. mrichter-reichhelm@kbv.de
authors.forename: M
authors.initials: M
authors.lastname: Richter-Reichhelm
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D002017:Budgets / Q000639:trends*; D003284:Contract Services / Q000191:economics*; D003363:Cost Control / Q000639:trends; D016527:Drug Costs / Q000639:trends; D005544:Forecasting; D005858:Germany; D015276:Health Care Rationing / Q000191:economics; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics