Hahn Ursula, Baulig Christine, Brzoska Patrick
Lehrstuhl für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke Fakultät für Gesundheit, Witten, Deutschland.
OcuNet GmbH & Co. KG, Düsseldorf, Deutschland.
Gesundheitswesen. 2021 May;83(5):337-344. doi: 10.1055/a-1390-3935. Epub 2021 Mar 25.
The image of outpatient medical care is physician-centered; little attention is paid to the (potential) influence of health organizations and their characteristics on medical care dimensions.
Description of the structures of outpatient medical care stratified by legal forms, comparison with those of other decentralized health systems and discussion of the potential effect of legal form on different dimensions of medical care.
The frequencies of solo practice, group practice and Medical Care Centers for both primary and specialist medical care, the average team size of practices and the proportion of interdisciplinary health organizations are described over time based on secondary data sources (mainly provided by the National Association of Statutory Health Insurance Physicians).
The structures of outpatient medical care are characterized by high fragmentation (2018:>80,000 health organizations), high proportion of small organizations (73% of all health organizations are solo practices), low average team size (1.7 physicians on average) and low proportion of interdisciplinary health organizations (17% of all group practices and Medical Care Centers). Overall, there is little indication that family and specialist care facilities tend to merge with each other.
The fragmentation of the German health care structure is more pronounced and lasting than in other decentralized health systems. Legal forms and average values do not adequately capture the heterogeneity of organizations in outpatient health care. In order to improve organization of medical care, a broader database including more organizational characteristics would be desirable.
门诊医疗的形象是以医生为中心的；很少有人关注卫生组织及其特征对医疗维度（潜在）的影响。
描述按法律形式分层的门诊医疗结构，与其他分散式卫生系统的结构进行比较，并讨论法律形式对医疗不同维度的潜在影响。
基于二手数据源（主要由法定医疗保险医生全国协会提供），描述初级和专科医疗中个体执业、团体执业和医疗护理中心的频率、执业的平均团队规模以及跨学科卫生组织的比例随时间的变化情况。
门诊医疗结构的特点是高度分散（2018年：超过80,000个卫生组织）、小型组织比例高（所有卫生组织中有73%是个体执业）、平均团队规模小（平均1.7名医生）以及跨学科卫生组织比例低（所有团体执业和医疗护理中心中有17%）。总体而言，几乎没有迹象表明家庭护理和专科护理设施有相互合并的趋势。
德国医疗保健结构的分散程度比其他分散式卫生系统更为明显和持久。法律形式和平均值无法充分体现门诊医疗中组织的异质性。为了改善医疗护理的组织，需要一个包含更多组织特征的更广泛数据库。
