John J, Potthoff P
Health Policy. 1987;8(2):153-69. doi: 10.1016/0168-8510(87)90058-3.
Among manifold attempts at containing the rapid growth of health care expenditure, one which attracted considerable attention was the 1979 agreement between Bavarian sick-funds and the office-based physicians of Bavaria that, in some ways, reshaped the remuneration scheme for ambulatory medical treatment. This so-called 'Bavarian Contract' tried to approach cost containment by initiating transsectoral substitution processes in favour of outpatient medical care and to the disfavour of, above all, the hospital sector of the health care system. This paper deals with the question whether in Bavaria (between 1979 and 1983/84) the structure of services and prescriptions was modified in a way that indicates the occurrence of substitution processes as intended by the 'Bavarian Contract'; also, whether there is any evidence of cost containment effects brought about the intensifying the ambulatory services of office-based physicians. The study results provide some weak hints at substitution processes in favour of ambulatory services; but there is no evidence that expanding ambulatory medical services may help to contain the growth of health care expenditure.
在控制医疗保健支出快速增长的诸多尝试中，一项备受关注的举措是1979年巴伐利亚州的疾病基金与该州的门诊医生达成的协议，该协议在某些方面重塑了门诊医疗的薪酬方案。这项所谓的“巴伐利亚协议”试图通过启动跨部门替代流程来控制成本，以利于门诊医疗，尤其是不利于医疗保健系统的医院部门。本文探讨的问题是，在巴伐利亚州（1979年至1983/84年期间），服务和处方结构是否以表明“巴伐利亚协议”所预期的替代流程发生的方式进行了调整；此外，是否有证据表明强化门诊医生的门诊服务带来了成本控制效果。研究结果提供了一些微弱的迹象，表明存在有利于门诊服务的替代流程；但没有证据表明扩大门诊医疗服务有助于控制医疗保健支出的增长。
