Werner B
Krankenhaus-Dezernat, im Medizinischen Dienst der Krankenversicherung Hamburg.
Chirurg. 1995 Jul;66(7):652-6.
Legal requirements of SGB V make provisions for quality assurance (QA) activities in relation to inpatient and outpatient care. Available contracts between health providers and institutions covering costs presently regulate QA in three distinct areas in surgery: inpatient and outpatient care, Fallpauschale (fee for case) and Sonderentgelte (fee for service), and out-patient surgical treatment. MDK as a medical counselling and review agency working on behalf of health insurance companies has a more or less well defined role in the organization (board membership) and actual work (evaluation and probing) of external QA. Its participation and competence derive from legal authorization (SGB V) and hence from its given assignments: review of indication, economical aspects and quality of services provided--each on a single case basis and on a more general basis, nursing care, hospital budgets and finally planning capacity for hospital care.
《社会法典》第五卷的法律规定对住院和门诊护理的质量保证（QA）活动做出了规定。目前，医疗服务提供者与机构之间涵盖费用的现有合同在手术的三个不同领域规范质量保证：住院和门诊护理、病例包干费（病例费用）和特殊服务费（服务费用）以及门诊手术治疗。作为代表健康保险公司工作的医疗咨询和审查机构，MDK在外部质量保证的组织（董事会成员身份）和实际工作（评估和调查）中或多或少有着明确的角色。其参与和权限源自法律授权（《社会法典》第五卷），因此源自其既定任务：对所提供服务的适应症、经济方面和质量进行审查——包括逐案审查和更全面的审查、护理、医院预算以及最终的医院护理规划能力。
