Wiechmann M
Versicherungsmedizin. 2004 Jun 1;56(2):80-6.
Much has been written about so-called Integrated Healthcare for a number of years and this healthcare model is regarded by many as the solution to our problems in the German healthcare system. Although the legal framework conditions for integrated healthcare models have existed since 2000, no operating model has yet been realised in the German statutory healthcare system (Gesetzliche Krankenversicherung, GKV). Given past experiences, the question therefore arises as to whether we need integrated healthcare models at all. The German health system provides healthcare at a very high level. It suffers nevertheless from constantly growing problems concerning decreasing quality at increasing costs. One of the reasons for this is the fact that past reforms set in the GKV did not remove structural deficits but were essentially symptom-oriented on a short-term basis. The financial relief of the past reforms therefore held only for a short time until the unresolved deficits then re-emerged as a growing problem--in terms of quality and costs. Structurally new forms of healthcare supply--so called Integrated Healthcare models--should integrate four areas: Contracts, supply, reimbursement and responsibility. The aim should be to achieve a high-quality healthcare supply at acceptable costs by appropriate selection of suitable healthcare providers and installation of efficient processes. International experience shows that a qualitatively better supply at reduced costs might be possible with Integrated Healthcare models.
多年来，关于所谓的整合式医疗保健已经有很多著述，这种医疗模式被许多人视为解决德国医疗体系问题的方案。尽管自2000年以来就存在整合式医疗模式的法律框架条件，但在德国法定医疗保险体系（Gesetzliche Krankenversicherung，GKV）中尚未实现任何运营模式。鉴于过去的经验，因此产生了一个问题，即我们是否真的需要整合式医疗模式。德国医疗体系提供的医疗保健水平非常高。然而，它却不断面临着质量下降、成本上升的问题。其中一个原因是，过去在法定医疗保险中进行的改革并没有消除结构性缺陷，而基本上只是短期的症状导向型改革。因此，过去改革带来的财政缓解只是暂时的，直到未解决的缺陷再次作为一个日益严重的问题出现——在质量和成本方面。从结构上来说，新的医疗供应形式——所谓的整合式医疗模式——应该整合四个领域：合同、供应、报销和责任。目标应该是通过适当选择合适的医疗服务提供者并建立高效的流程，以可接受的成本实现高质量的医疗供应。国际经验表明，整合式医疗模式有可能在降低成本的同时提供质量更高的医疗服务。
