title: [Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the perspective of the hospital-based physician].
abstract: The partitioning of patient care into an ambulatory and stationary sector, which has been in existence for decades, was wanted from a general political and economic point of view and has since been a guarantee for high-quality care in both sectors. The demographic development and scientific medical advances leading to higher life expectancy in the face of increasingly sparse resources have made us recognise that there might be a considerable cost-saving potential in promoting stronger integration of stationary and ambulatory care. The trend towards increased specialisation of the medical profession, but also the emergence of new professions within the health care sector require increasing efforts to ensure consistent courses of treatment and the necessary interdisciplinary and interprofessional continuity. But given insufficient budgets and the resultant distribution conflicts within this system the situation will become more critical. Integration does not simply happen, it must be wanted, designed and organised. It is dependent on crossborder co-operation and interface competence, especially general conditions promoting instead of inhibiting co-operation and integration. This requires an integrative system of patient care opening its borders on both sides. If this system which is intended to ensure an open and holistic concept of care is to be directed towards the individual patient, the transfer of care between the ambulatory and stationary sectors must not be system-related and thus imply that the patient will have to change his doctor(s) without being asked. Integrative care can and will be successful if general conditions are established that allow the medical profession to meet the challenges of integration and interface organisation, the lack of which is the result of misguided health care policy and not a failure that can be blamed on health care providers.
authors.affiliation: Krankenhaus der Augustinerinnen, Abteilung für Innere Medizin, Köln. dr.mitrenga@koeln-kh-augustinerinnen.de
authors.forename: Dieter
authors.initials: D
authors.lastname: Mitrenga
mesh_terms: D005858:Germany; D006739:Hospital Administration; D006740:Hospital Administrators / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital