Hoopmann M, Schwartz F W, Weber J
Institut für Sozialmedizin, Epidemiologie, und Gesundheits-systemforschung (ISEG), Hannover, Germany.
J Epidemiol Community Health. 1995 Aug;49 Suppl 1(Suppl 1):33-6. doi: 10.1136/jech.49.suppl_1.33.
An empirical study in Lower Saxony aimed to investigate any changes in primary care physicians' diagnostic and therapeutic strategies as a result of Germany's 1993 health reform act (known as the Gesundheitsstruktur Gesetz or GSG), which included the countrywide implementation of a strict drug budget. A sentinel network consisting of a 37% sample of 350 randomly selected doctors (n = 130, GPs, general internists) was established in Lower Saxony. Four cross sectional surveys, each focussing on one group of health problems, were carried out during 1993. These aimed to show whether sentinel practice networks are suitable for reporting physicians' attitudes towards health care cost containment policies and, secondly, changes in physicians' quantitative and qualitative assessments of the 1993 reform act during its first year of implementation. Participating physicians reported patient consultations (n = 3728). Standardised questionnaires ascertained sociodemographic variables and major reasons for the patients' visit. Data on the diagnoses associated with the patient's main reason for the consultation, the doctor's assessment of the severity of the problem, and diagnostic and treatment strategies were also recorded. The questionnaire focussed on changes in therapy made by the physician together with the reasons for these changes. A number of treatment changes made with regard to cost containment were recorded. During the course of 1993 a decrease in reported changes in treatment was noticed. As expected, some doctors recorded a reduction in successful outcomes of treatment and ascribed this to the reform act. Differences between the four surveys with regard to the influence of the health reform act on the frequency of changes in treatment and the physicians' expectations cannot be explained sufficiently by the physicians' adaptation to the cost containment policies within the year.
下萨克森州的一项实证研究旨在调查德国1993年医疗改革法案（即《卫生结构法》或GSG）实施后，初级保健医生的诊断和治疗策略是否发生了变化，该法案包括在全国范围内实施严格的药品预算。在下萨克森州建立了一个由350名随机挑选医生（n = 130，全科医生、普通内科医生）组成的37%样本的哨点网络。1993年期间进行了四项横断面调查，每项调查聚焦于一组健康问题。这些调查旨在表明哨点实践网络是否适合报告医生对医疗成本控制政策的态度，其次，调查1993年改革法案在实施的第一年中医生在定量和定性评估方面的变化。参与的医生报告了患者咨询情况（n = 3728）。标准化问卷确定了社会人口统计学变量以及患者就诊的主要原因。还记录了与患者咨询主要原因相关的诊断数据、医生对问题严重程度的评估以及诊断和治疗策略。问卷重点关注医生所做的治疗变化及其原因。记录了一些出于成本控制目的而进行的治疗变化。在1993年期间，注意到报告的治疗变化有所减少。正如预期的那样，一些医生记录到治疗成功结果有所下降，并将此归因于改革法案。四项调查在医疗改革法案对治疗变化频率的影响以及医生期望方面存在差异，这无法完全通过医生在这一年中对成本控制政策的适应来解释。
