[Innovation, quality and economic efficacy of competitive health care--contribution to the "Healthy North Rhine-Westphalia" Project].

This is a report on what the Provincial Government of North Rhine Westphalia, the most densely populated area in Germany, has been doing to ensure that the various health establishments (such as, for example, hospitals, nursing homes, rehabilitation clinics, and so on) engaged in serving the public, shall act in solidarity jointly and severally in striving for maximum innovation, quality and efficiency while observing all the rules of competitive fairness. This approach was initiated by the Federal German government in 1993 by promulgating a law reforming the structural setup of all organisations engaged in health service work. From 1996 onward these institutions will be operating within the framework of rules ensuring mutual solidarity on a competitive basis. The general trend is to increase self-administration and a wider scope of activities and creative initiative based on imagination and economy, the latter becoming increasingly imperative to avoid wasteful working. In other words: By encouraging competition directed at a maximum of innovation, quality and economy, the main targets of public health policy will be finally within reach: to maintain the quality standards of public health services, to promote general access to these services, and also to provide a sound financial basis for them.