[Influence of the reimbursement system on medical quality].
BACKGROUND
The relationship between reimbursement for medical care and the quality of medicine is mostly discussed if there are warnings about underuse as a consequence of underpayment. By various examples it can be illustrated that not only a lack of services but also an overuse of medical care may be hazardous and reduce quality in medicine. This relates to the risk, which is part of each medical intervention.
The introduction of the Diagnosis Related Groups (DRGs) in Germany is at present mostly discussed under the aspect of a possible risk of underuse. On the other hand, there are chances for the quality of medicine as a result from a lean diagnostic and therapy, which will be the consequence of economic changes induced by the DRGs. A guideline-oriented medicine will often avoid unnecessary procedures and thereby improve the quality of medical services.


CONCLUSIONS
Loss of quality and improvement of quality arise in the field of medicine from overuse as well as from underuse. Most important for an optimal quality is a quantitatively appropriate treatment. In general, we observe that medical decisions are more and more oriented on economic frames. It has to be observed during forthcoming years to what extent ethical problems arise by this situation.
von Schroeders
Nikolai
N
Zentrum für Innere Medizin, Kliniken St. Antonius, Wuppertal. nikolai.schroeders@gmx.de
Köbberling
Johannes
J
D005858:Germany; D006300:Health Services Misuse / Q000191:economics; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics