title: [Quality management within the requirements of current health care policy; introduction--political and institutional aspects].
abstract: The implementation of a DRG-based payment system for hospitals and the introduction of managed care features in health care plans covering care for in- and outpatients lead to an increased cost pressure on the inpatient sector. Quality assessment and quality management programs are considered a useful tool to support the process of restructuring and reorganizing hospitals as an reaction to this situation. However, changed incentives introduced by the new payment system, as risk selection or decrease of length of stay, have the potential to worsen quality in health care. As a result, the recent health care reform included a large number of quality control issues such as quality assessment, internal quality management, clinical guidelines, and evidence-based medicine. From the viewpoint of internal quality control programs, the situation is controversial, because the internal and external motivation for these programs are not identical. While the internal reason to invest in quality management is given by rationalizing processes, development of the organization and, in some cases, to optimize documentation, health legislation is primarily interested in avoiding quality problems. Health legislation is now faced with the task to build up a framework which supports quality of health care as a major argument in competition on the health care market.
authors.affiliation: Zentrale Dienstleistungseinrichtung für Qualitätsmanagement des Klinikums der Universität zu Köln. Matthias.Schrappe@medizin.uni-koeln.de
authors.forename: M
authors.initials: M
authors.lastname: Schrappe
mesh_terms: D003953:Diagnosis-Related Groups / Q000191:economics; D019317:Evidence-Based Medicine / Q000592:standards; D005858:Germany; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards*; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D006739:Hospital Administration / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards*; D006754:Hospital Restructuring; D006801:Humans; D011057:Politics; D017749:Total Quality Management / Q000331:legislation & jurisprudence*