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'Ambulante Behandlungen im Krankenhaus werden vom Gesetzgeber zunehmend gefördert. Angesichts möglicher Kostenunterdeckungen und Mengenbudgetierungen ist die Wahl der besten Strategie für Krankenhäuser bisher unklar. Auf der Basis von 16.171 an 6 Hochschulkliniken in Deutschland prospektiv dokumentierten Konsultationen in Ermächtigungsambulanzen (3.219 Konsultationen) und Hochschulambulanzen (12.952 Konsultationen) wurden von den Autoren Kosten und Erlöse gegenüber gestellt. Der Deckungsgrad lag je nach Ambulanzart bei 27% bis 29% bezogen auf die Gesamtkosten (44% bis 47% bezogen auf die Primärkosten). Da diese Unterdeckung zu einer Unterversorgung der Bevölkerung bei spezialisierter ambulanter Behandlung führen kann, ist auch aus gesundheitspolitischer Sicht eine Überprüfung der Finanzierung sinnvoll.' (Autorenreferat) 'The delivery of ambulatory care in hospitals is broadened by legislative actions in Germany. However, best strategies for hospitals are unclear due to consideration of costs, reimbursements and budgeting. We included 16,171 prospectively documented consultations from six university hospitals in Germany. The ratio of reimbursement to total cost was 27% to 29%, concerning to the type of ambulatory care. (44% to 47% concerning to variable costs). This financial deficit could cause a shortage of highly specialized ambulatory services. Health policy interventions might be necessary.' (author's abstract)

'Background: On July 1, 1997, the German government raised drug copayment by EUR2.60 to EUR 4.60, EUR 5.60 or EUR 6.60 per prescription, depending on package size. The aim of this study was to examine the effects of increased copayments on the demand for drugs and physician visits one year later. Lower income groups and the chronically ill were analysed separately. Methods: A survey of 695 non-exempted adult pharmacy customers who suffered from acute or chronic health conditions in the previous 12 months was conducted. Logistic regression was performed to analyse the effect of different income levels on the demand for drugs and physician visits. Results: Of the respondents, 19.9% reported reduced physician visits, 22.6% reported reduced prescription drug purchases, 44.9% reported increased use of over-the-counter products and 46.3% reported increased use of non-drugs such as household remedies. A total of 11.2% waived more than one visit to the physician. Almost all of those respondents who reduced their purchases of prescription packages waived 1 to 5 packages (82.5%). There was distinctly less change in purchasing patterns among persons with chronic diseases. Logistic regression confirmed that lower income households were more likely to change demand patterns than households in other income brackets. Conclusion: Increased copayments had little effect on drugs and physician visits of adult pharmacy customers, especially among those with chronic conditions. Negative effects on low income households were observed.' (excerpt)