Dreher Wolfgang
Bundessozialgericht, Kassel.
Z Arztl Fortbild Qualitatssich. 2004 Sep;98(6):489-93.
Beyond all differences in terminology and legal principles between the laws governing private health insurance, the governmental financial support for civil, servants and statutory health insurance the fundamental issues to be solved by the courts in case of litigation are quite similar. But only a part of these refer to the quality of medical services, which is the main concern of Evidence-based Medicine (EbM); EbM, though, is not able to contribute towards answering the equally important question of how to distinguish between "treatment" and "(health-relevant) lifestyle". The respective definitions that have been developed in the particular fields of law are only seemingly divergent from each other and basically unsuitable to aid the physician in his clinical decision-making because the common blanket clauses of public health law are regularly interpreted as rules for the exclusion of certain claims and not as a confirmatory paraphrase of what is clinically necessary. If on the other hand medical quality is what lies at the core of litigation, reference to EbM may become necessary. In fact, it is already common practice in the statutory health insurance system that decision-making processes in the Federal Committee being responsible for quality assurance (Bundesausschuss) are based on EbM principles and that in exceptional cases only the courts have to medically review the Federal Committee's decisions.
除了管理私人健康保险的法律在术语和法律原则上存在差异，以及政府对公务员和法定健康保险的财政支持外，法院在诉讼案件中需要解决的基本问题非常相似。但其中只有一部分涉及医疗服务质量，这是循证医学（EbM）的主要关注点；然而，循证医学无法帮助回答如何区分“治疗”和“（与健康相关的）生活方式”这一同样重要的问题。在特定法律领域中形成的各自定义表面上似乎相互不同，而且基本上不适合帮助医生进行临床决策，因为公共卫生法的通用总括条款通常被解释为排除某些索赔的规则，而不是对临床必要性的确认性释义。另一方面，如果医疗质量是诉讼的核心，那么参考循证医学可能就变得必要。事实上，在法定健康保险系统中，负责质量保证的联邦委员会（Bundesausschuss）的决策过程基于循证医学原则，并且在特殊情况下只有法院必须对联邦委员会的决定进行医学审查，这已经是常见的做法。
