title: [Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the point of view of the hospital owners].
abstract: Structural changes in the financing of hospital-based health care in Germany make a revision of the currently existing strict separation between ambulatory and stationary patient care inevitable. The present monopolist situation of office-based physicians (organised in private practices without any legal or financial relation to a hospital) will be amended by the participation of hospitals and hospital-employed doctors in ambulatory services of a different kind. These may include the institutional authorization of hospitals to participate in ambulatory services, especially in the case of emergencies and first aid, and co-operations between doctors in private practices and hospitals. Such co-operations are now legally enabled to provide "integrated services", but still lacking acceptance by the parties involved in the health care services. Ambulatory medical care is an already huge and now rapidly growing market, whereas the classical hospital services represent a declining product. Therefore hospitals will have to act accordingly or they will even forfeit the opportunity to use the ambulatory care sector to improve the intensity of utilisation of their hospital beds. In addition, hospitals will have to accept that office-based doctors are their customers and have to be treated as such. The establishment of regional networks may be a solution to this problem. Integrated services can only be established if new ways of co-operation and knowledge transfer are introduced into this area step by step. The present article provides practical examples of co-operation models.
authors.affiliation: kersting@drk-kliniken.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Kersting
mesh_terms: D005858:Germany; D006739:Hospital Administration / Q000592:standards*; D006740:Hospital Administrators / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D010564:Personnel, Hospital / Q000592:standards*