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[资深医生对西德医疗体系有何期望?经济评估导致的费用削减和药品管控。能做些什么?]

[What does the established physician expect from the West German health system? Fee reduction and drug control as a consequence of economic assessment. What can be done?].

作者信息

Broglie M G

出版信息

Z Gesamte Inn Med. 1990 Sep 15;45(18):556-60.

PMID:2291283
Abstract

We have briefly tried to inform about the fact why controls of profitableness have to be carried out, how is their course and by virtue of which standards the unprofitableness is assessed. In form of a randomized summary we will once more specify what the physician by all means should do if the fee is reduced or a drug recourse takes place: 1. The date of receipt is to be written clearly visible on the control rescript, since this is of importance for the grace when legal remedies may be applied. 2. Test the rescript, whether or not the reducing or the recourse seems to be justified or whether you have the impression that the data of your activity and management of your practice have not been fully taken into consideration. In this case you at once object and announce a detailed argument. 3. Test quietly, after the first irritation has subsided, whether the points of view explained in the paragraphs 3 and 4 have been taken into consideration, in particular: a. Is the comparative group right? b. Is the present elevation of the average values suited to justify the reducing measure performed? c. Are all peculiarities of the practice taken into consideration? d. Are the peculiarities of the practice sufficiently exactly quantified? e. Was a possible compensatory less expenditure taken into consideration? 4. Summarize the result of your own inquires, as they are described in item 3, in a relevant argument as short as possible. If you need statistical data, which are not at your disposal, for writing this argument, so request such data from the control department of your health-insurance company. 5. In a drug recourse you control, whether or not you can acknowledge the judgment of the arguments for reducing declared. Otherwise you request from your health insurance company the examination into the adequate prescriptions, in which case you probably have to go into the business premises of your health insurance company, in order to be able to take notes there.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

我们已简要介绍了为何必须进行盈利性控制、其流程如何以及依据哪些标准评估无盈利性。以随机总结的形式,我们将再次明确,如果费用降低或药品报销发生,医生务必采取的措施:1. 收取日期应清晰可见地写在控制指令上,因为这对可采取法律补救措施的宽限期很重要。2. 检查指令,看费用降低或报销是否合理,或者你是否觉得自己业务活动和诊所管理的数据未得到充分考虑。若如此,应立即提出异议并陈述详细理由。3. 在最初的恼怒平息后,悄悄检查第3段和第4段所解释的观点是否被考虑到,特别是:a. 对比组是否正确?b. 当前平均值的提高是否足以证明所采取的降低措施合理?c. 诊所的所有特殊情况是否都被考虑到?d. 诊所的特殊情况是否得到充分准确的量化?e. 是否考虑了可能的补偿性较低支出?4. 将你在第3项中所述的自身调查结果,尽可能简短地总结成一个相关论据。如果你在撰写此论据时需要无法获取的统计数据,可向你的健康保险公司控制部门索要此类数据。5. 在药品报销时,检查你是否能认可所宣称的降低报销理由的判断。否则,你可要求健康保险公司对适当的处方进行审查,这种情况下你可能得前往健康保险公司的营业场所以便能在那里做记录。(摘要截选至250字)

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