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Qualitäts- und Kostensteuerung

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Managed Care

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Zusammenfassung

Unter dem Konzept des gatekeepings wird verstanden, daß jede Behandlungsepisode, mit Ausnahme von Notfällen und einigen vorab definierten Leistungsbereichen, mit einem Besuch bei einem individuell bestinmiten Allgemeinarzt beginnt. Der Versicherte delegiert die Entscheidung, ob die benötigten Leistungen von diesem selber erbracht werden, ob ein Facharzt konsultiert werden soll oder gar ein Krankenhausaufenthalt notwendig ist an seinen gatekeeper. Sämtliche Leistungen werden somit von diesem erbracht oder zumindest veranlaßt.

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Literatur

  • Baumann, M.; Stock, J. (1996), Managed Care - Impulse für die GKV?, Prognos- Gutachten im Auftrag der Hans-Böckler-Stiftung, Düsseldorf 1996

    Google Scholar 

  • Böhlert, I. et al. (1997a), Das Schweizer Gatekeepersystem - ein Modell zur Verbesserung der Leistungsentwicklung und Wirtschafthchkeit, in: Gesundheitswesen, 59 (1997), S. 488–94

    Google Scholar 

  • Böhlert, L et al. (1997b), Voraussetzungen zur erfolgreichen Umsetzimg von Managed Care - Gatekeepersystem nach dem Schweizer Muster in Deutschland, in: Gesundheitswesen, 59 (1997), S. 555–60

    Google Scholar 

  • Franks P. et al. (1992), Gatekeeping Revisted - Protecting Patients From Overtreat- ment, in: The New England Journal of Medicine, Aug. 6, 1992, S. 424–27

    Google Scholar 

  • Kingdom, J. (1996), The United Kingdom, Wall, A., Health Care Systems in Liberal Democracies, London 1996, S. 127–162

    Google Scholar 

  • Klein, R. (1996), The New Politics of NHS, 3. Auflage, Essex 1996

    Google Scholar 

  • OECD Health Data 1997, (1997) CD-ROM, Paris 1998

    Google Scholar 

  • Ottewill, R. (1996), The Netherlands, in: Wall, A., Healüi Care Systems in Liberal Democracies, London 1996, S. 76–103

    Google Scholar 

  • Payer, L. (1996) Medicine and Culture, 2. Auflage, New York 1996

    Google Scholar 

  • Robinson, R., Steiner, A. (1998) Managed Healtli Care US Evidence and Lessons for the National Health Service, Buckingham 1998

    Google Scholar 

  • Sachverständigenrat der Konzertierten Aktion im Gesundheitswesen (SVRKAiG) (1992) Jaliresgutachten 1992, Baden-Baden 1992

    Google Scholar 

  • Zelman W., Berenson R. (1998), The Managed Care Blues & How to Cure Them, Washington D.C. 1998

    Google Scholar 

Section 1: Literatur

  • Amelung, V. E. (1998), Guidelines: Standardisierung medizinischer Leistungserstellung? Eine kritische Analyse; in: Fischer, Helmuth et al., Management Handbuch Krankenhaus, 13. Ergänzungslieferung, Heidelberg, Juni 1998

    Google Scholar 

  • Emanuel, E. J., Goldman, L. (1998), Managed Care: Six Safeguards, in: Journal of Healtii Politics, Policy and Law, Vol. 23, No. 4, Aug. 1998

    Google Scholar 

  • Pauly, M. V. (1995), Practice guidelines: Can They Save Money? Should They?, in: Journal of Law, Medicine & Ethics, S.65–74

    Google Scholar 

  • Robinson, R.; Steiner, A. (1998), Managed Healtii Care US Evidence and Lessons for tiie National Healtii Service, Buckingham 1998

    Google Scholar 

  • Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen (SVRKAiG) (1998), Gesundheitswesen in Deutschland, Band 2, Baden-Baden 1998

    Google Scholar 

  • Selbmann, H.-K. (1995), Qualitätsmanagement und Behandlungsleitlinien im Krankenhaus, in: Arnold M., Paffrath D., Krankenhausreport ‘95, Stuttgart 1995, S. 177–189

    Google Scholar 

  • Thiemann, H. (1996), Clinical Pathways, Instrumente zur Qualitätssicherung, in: f&w im Krankenhaus, 5/1996, S.454–57

    Google Scholar 

  • James, B. (1995), Implementing Practice Guidelines through Clinical Quality Improvement, in: Graham, N. O., Quahty in Health Care, Gaithersburg 1995

    Google Scholar 

  • United States General Accounting Office (GAO) (1996), Practice Guidelines - Managed Care Plans Customize Guidelines to Meet Local Interests, Washington 1996

    Google Scholar 

  • Reinauer, HJ. (1998), Leitlinien fur Diagnosen und Therapie in Deutschland, in: Bundesministerium für Gesundheit, Leitlinien in der Geundheitsversorgung - Bericht einer WHO-Konferenz, Schriftenreihe des BMG, Band 104, Baden-Baden 1998, S. 91- 94

    Google Scholar 

  • Lohr, K. N. (1998), The Quaüty of Practice Guidelines and the Quality of Health Care, in: Bundesministerium für Gesundheit, Leitlinien in der Geundheitsversorgung - Bericht einer WHO-Konferenz, Schriftenreihe des BMG, Band 104, Baden-Baden 1998, S. 42- 52

    Google Scholar 

Section 2: Literatur

  • Blissenbach H. F., Penna P. M. (1996), Pharmaceutical Service in Managed Care, in: Kongstvedt, P R., The Managed Health Care Handbook, 3. Auflage, Gaithersburg 1996, S. 367–387

    Google Scholar 

  • Herder-Dorneich, P. (1994), Ökonomische Theorie des Gesundheitswesens, Baden- Baden 1994

    Google Scholar 

  • Hoechst Marion Roussel (1998), HMO-PPO/Medicare/Medicaid Digest, Kansas City 1998

    Google Scholar 

  • Reifter, W. (1997), Managed Care und die phannazeutische Industrie, in: Arnold O et al., Managed Care, Stuttgart 1997

    Google Scholar 

  • Shapiro H. M. (1997), Managed Care Beware, West Hollywood 1997

    Google Scholar 

Section 3: Literatur

  • Hunter, D. J., Fairfield, G. (1997), Managed Care: Disease Management, in: British Medical Journal, 314, S. 50–53.

    Article  Google Scholar 

  • Bernard, S. (1997), The Roles of Pharmaceutical Companies in Disease Management, in: Todd, W. E., Nash, D. (eds). Disease Management A System Approach to Improving Patient Outcomes, Chicago, S. 179–205.

    Google Scholar 

  • Corrigan, J. J. et al. (1997), Trends toward a National Health Care Marketplace, in: Inquiry, 34, S. 11–28.

    Google Scholar 

  • Richert, J. H., The Disease Management Development Process, in: Todd, W. E., Nash, D. (eds). Disease Management. A System Approach to Improving Patient Outcomes, Chicago, 1997, S. 27–59.

    Google Scholar 

  • Ellrodt, G. (1997), Evidence-Based Disease Management, in: JAMA, 278, S. 1687- 1692.

    Article  Google Scholar 

  • Gold, M. (1999), The Changing US Health Care System, in: The Milbank Quarterly, 77, S. 113–137.

    Article  Google Scholar 

  • Neuffer, A. B. (1997), Managed Care. Umsetzbarkeit des Konzepts im deutschen Gesundheitssystem, Diss. St. Gallen.

    Google Scholar 

  • Kühn, H. (1997), Managed Care. Medizin zwischen kommerzieller Bürokratie und integrierter Versorgung. Am Beispiel USA, Berlin.

    Google Scholar 

  • Peterson, K. W., Kane, P. D. (1997), Beyond Disease Management: Population-Based Health Management, in: Todd, W. E., Nash, D. (eds), Disease Management. A System Approach to Improving Patient Outcomes, Chicago, 1997, S. 305–346.

    Google Scholar 

  • Plocher, D. (1996), Disease Management, in: Kongstvedt, P. R. (ed.), The Managed Health Care Handbook, Gaiüiersburg, S. 318–347.

    Google Scholar 

  • Zitter, M. (1997), A New Paradigma in Health Care Delivery: Disease Management, in: Todd, W. E., Nash, D. (eds), Disease Management. A System Approach to Improving Patient Outcomes, Chicago, S. 1–25.

    Google Scholar 

Section 4: Literatur

  • Cesta, T. G. et al. (1998), The Case Managers’ Survival Guide: Winning Strategies flir Clinical Practice, St Louis.

    Google Scholar 

  • Coffey, R. J. et al. (1992), An Introduction to Critical Path, in: Quality Management in Healthcare, 1, S. 45–54.

    Article  Google Scholar 

  • Mullahy, C. M. (1996), Case Management and Managed Care, in: Kongstvedt, P. R. (ed.), The Managed Health Care Handbook, Gaithersburg, S. 274–300.

    Google Scholar 

  • Mullahy, C. M. (1995), The Case Manager’s Handbook, Gaithersburg.

    Google Scholar 

  • Naylor, M. D. et al. (1999), Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders. A Randomized Clinical Trial, in: JAMA, 281, S. 613–620.

    Article  Google Scholar 

  • Wagner, E. H. (1998), More Than a Case Manager, in: Annals of Internal Medicine, 129, S. 654–616.

    Google Scholar 

  • Ward, M. D., Rieve, J. A. (1997), The Role of Case Management in Disease Management, in: Todd, W. E., Nash, D. (eds). Disease Management. A System Approach to Improving Patient Outcomes, Chicago, S. 235–259.

    Google Scholar 

Section 5: Literatur

  • Brown, L. D. (1996), American Health Care in Transition: A Guide to the Perplexed, Grantinaker Assistance Program, Washington 1996

    Google Scholar 

  • Ginzberg, E. (1996), Tomorrow’s Hospital, New Haven 1996

    Google Scholar 

  • Health Care Consultants of America (HCCA) (1996), Physicians Guide to Managed Care, Augusta 1996

    Google Scholar 

  • Kongstvedt, P. R. (1996), Managing Basic Medical-Surgical Utilization, in: Kongstvedt, Peter R., The Managed Care Handbook, Gainsburg 1996

    Google Scholar 

  • Payne, S. et al. (1991), Using Utilization Review Infonnation to Improve Hospital Efficiency, Hospital&Health Service Administration, 36:4, Winter 1991, S. 473–489

    Google Scholar 

  • Remler, D. K (1997), What Do Managed Care Plans Do to Effect Care? Results from a Survey of Physicians, in: Inquiiy, Fall 1997, 34:196–204

    Google Scholar 

  • Restijccia, J. D. (1995), The Evolution of Hospital UtiUzation Review Methods in the United States, in: International Journal for Quahty in Health Care, Vol. 7, No. 3, S. 253- 260

    Article  Google Scholar 

  • Robinson, R., Steiner, A. (1998), Managed Health Care US Evidence and Lessons for the National Health Service, Buckingham, 1998

    Google Scholar 

  • Rosenberg, St. et al. (1995), Effects of Utilization Review in a Fee-For-Service Healtii Insurance Plan, in: The New England Journal of Medicine, Vol. 333, S. 1326- 1330

    Article  Google Scholar 

  • Schlesinger, M. et al. (1997), Medical Professionalism Under Managed Care: The Pros And Cons Of Utilization Review, in: Health Affairs, Jan./Feb. 1997, S. 106–24

    Google Scholar 

  • Smith, D. G. (1992), Hospital-Reviewer Relations and Effective Utilization Review, in: Hospital&Health Service Administration, 37:3, Fall 1992, S. 359–71

    Google Scholar 

  • Wickizer, T. M. (1992), The Effects of Utilization Review on Hospital Use and Expenditures: A Covariance Analysis, in: Health Service Research 27:1, April 1992, S. 103–21

    Google Scholar 

  • Zelman W., Berenson R. (1998), The Managed Care Blues & How to Cure Them, Washington D.C. 1998

    Google Scholar 

Section 6: Literatur

  • Berwick, D. M. et al. (1990), Curing Health Care: New Strategies for Quality Improvement, San Francisco.

    Google Scholar 

  • Blumenthal, D. (1993), Total Quality Management and Physicians’ CUnical Decisions, in: JAMA, 269, S. 2775–2778.

    Article  Google Scholar 

  • Blumenthal, D. (1996), Quahty of Health Care, Part 1, in: The New England Journal of Medicine, 335, S. 891–894.

    Article  Google Scholar 

  • Bungard, W. et al. (Hrsg.), (1992), Qualitätszirkel im Umbruch, Ludwigshafen.

    Google Scholar 

  • Donabedian, A. (1966), Evaluating the Quality of Care, in: Milbank Memory Fund Quarterly, 44, Pt 2, 166–203.

    Article  Google Scholar 

  • Donabedian, A. (1992), The Role of Outcomes in Quality Assessment and Assurance, in: Quality Review Bulletin, 18, S. 356–360.

    Google Scholar 

  • Eichert, J. H. et al. (1997), The Disease Management Development Process, in: Todd, W. E., Nash, D. (eds). Disease Management. A System Approach to Improving Patient Outcomes, Chicago, S.27–60.

    Google Scholar 

  • Epstein, A. M. (1998), Rolling Down the Runway: the Challenges Ahead for Quality Report Cards, in: JAMA, 279, S. 1691–96.

    Article  Google Scholar 

  • Gift, R., Mosel, D. (1994), Benchmarking in Health Care. A Collaborative Approach, AHA, USA.

    Google Scholar 

  • Hackman, J. R., Wageman, R. (1995), Total Quality Management: Empirical, Conceptual, and Practical Issues, in: Adminstrative Science Quarterly, 40, S. 309–342.

    Article  Google Scholar 

  • Hoechst Marion Roussel (1998), Medical Group Practice Digest. Managed Care Digest Series, Kansas City.

    Google Scholar 

  • Kerr, E. A. et al. (1996), Quality Assurance in Citated Physician Groups, in: JAMA, 276, S. 1236–1239.

    Article  Google Scholar 

  • Kessner, D. M. et al. (1971), Accessing Health Quality - The Case of Tracers, New England Journal of Medicine, 288, S. 189–94.

    Article  Google Scholar 

  • Nelson, E. C., Bataldan, P. B. (1997), Patient-Based Quality Measurement System, in: Kongstvedt, P. R. (ed.). Readings in Managed Health Care, Gaithersburg, S. 166–188.

    Google Scholar 

  • Siren, P. B., Laffel, G. L. (1996), Quality Management in Managed Care, in: Kongstvedt, P. R. (ed.). The Managed Health Care Handbook, Gaithersburg, S. 402–26.

    Google Scholar 

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Author information

Authors and Affiliations

  1. habilitiert sich an der Hochschule für Wirtschaft und Politik, Hamburg, Deutschland

    Dr.oec. Volker Eric Amelung (Visiting Professor)

  2. Division of Health Policy and Management, Columbia University, New York, USA

    Dr.oec. Volker Eric Amelung (Visiting Professor)

  3. lehrt Volkswirtschaftslehre, Hochschule für Wirtschaft und Politik, Hamburg, Deutschland

    Prof.Dr. Harald Schumacher

Authors
  1. Dr.oec. Volker Eric Amelung
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  2. Prof.Dr. Harald Schumacher
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© 1999 Betriebswirtschaftlicher Verlag Dr. Th. Gabler GmbH, Wiesbaden

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Amelung, V.E., Schumacher, H. (1999). Qualitäts- und Kostensteuerung. In: Managed Care. Gabler Verlag. https://doi.org/10.1007/978-3-322-92058-4_10

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  • DOI: https://doi.org/10.1007/978-3-322-92058-4_10

  • Publisher Name: Gabler Verlag

  • Print ISBN: 978-3-409-11500-1

  • Online ISBN: 978-3-322-92058-4

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