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2022 | OriginalPaper | Chapter

11. Qualitäts- und Kostensteuerung

Author: Volker Eric Amelung

Published in: Managed Care

Publisher: Springer Fachmedien Wiesbaden

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Zusammenfassung

Unter dem Konzept des Gatekeepings wird verstanden, dass jede Behandlungsepisode mit Ausnahme von Notfällen und einigen vorab definierten Leistungsbereichen mit einem Besuch bei einem individuell bestimmten Allgemeinarzt beginnt. Entsprechend wird auch von Hausarztmodellen gesprochen. Der Versicherte delegiert die Entscheidung, ob die benötigten Leistungen von diesem selbst erbracht werden, ob ein Facharzt konsultiert werden soll oder gar ein Krankenhausaufenthalt notwendig ist, an seinen Gatekeeper. Sämtliche Leistungen werden somit von diesem erbracht oder zumindest veranlasst.
Footnotes
1
In den USA kamen 2009 auf 1000 Einwohner 0,3 primary care physicians (OECD Health Data, 2011), in Deutschland waren es 0,7.
 
2
In der Literatur wird auch vom Primärarztsystem gesprochen. Vgl. z. B. Sachverständigenrat in seinem Jahresgutachten 1992. (SVRKAiG, 1992, S. 316 ff.).
 
3
Klassisches Beispiel ist die Frage nach Mammografien bei unter 50-jährigen Frauen, worüber die Ansichten sehr weit auseinander gehen.
 
4
In den USA gibt es zwei Arten von Krankenschwestern mit sehr unterschiedlichen Qualifikationsprofilen. Registrierte Nurses (RNs) absolvieren ein Studium, während Nurse Practitioners eine Berufsausbildung absolvieren.
 
5
In einem weiteren Sinne können zu den Kunden auch die Öffentlichkeit bzw. staatliche Behörden oder Verbände gehören, die die Qualität nach ethischen Kriterien oder nach ihrer Konformität mit rechtlichen und selbst gesetzten Normen beurteilen.
 
6
Die CMS (Centers for Medicare & Medicaid Services), früher bekannt unter HCFA (Health Care Financing Administation) ist eine Bundesbehörde, die das Medicare-Programm verwaltet und die Durchführung der einzelstaatlichen Medicaid-Programme überwacht.
 
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Metadata
Title
Qualitäts- und Kostensteuerung
Author
Volker Eric Amelung
Copyright Year
2022
DOI
https://doi.org/10.1007/978-3-658-12527-1_11

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