[Growth in the number of physicians and the structure of medical practice. Has the quality of ambulatory care changed?].

In order to realize a good health policy that, over the long term, combines humanity, effectiveness and efficiency, corrections in the evolution of the number of physicians, changes in the structure of practices, and the preservation of quality in ambulatory care are urgent tasks for the remaining decade of this century. In this connection, the development of medical orientational data and the so-called priority health aims, will be of use. In particular, the system of "health-insurance" doctors is threatened by external influences outside the control and authority of the administrative organs concerned. Here, the influence on the overcapacity of doctors arises in the present constitutional provision which states that all those physicians who wish to work within the health-insurance system, must be allowed to do so. Owing to the increasing "financial bottlenecks" that health-insurance doctors will encounter, the future practicing physician will increasingly become a "businessman", since rising costs and decreasing turnover will exercise a powerful effect on the doctor's practice. In such a situation new practice structures might have a positive effect. In view of all these factors that threaten the independence of the practicing physician, the difficulty arises of preserving the quality of medical care. Already, attempts are being made, on an "outside the medical profession" basis, to ensure quality control, and the proposals made by the expert councils are an indication that this discussion must be intensified among the medical profession itself.