Task force on German fraud disillusioned.

OBJECTIVES: Expansion of newborn screening programs may increase the risk of missing cases through procedural failures. A coordinated process quality assurance procedure to track recalls was, therefore, introduced in parallel to expansion (including MS-MS and 17alpha-OHP) in Bavaria. METHODS: Using comprehensive computerized registration and automated monitoring a state-funded center coordinated all individual measures to achieve complete testing of all repeat requests-case-specific contacts to physicians, midwives, and parents. Mailing and phoning from the center were supplemented by local public health activities including home visits if needed. RESULTS: Among 243,422 children tested in 1999 and 2000 overall recall was 3.62% (8,809 children): 0.30% (726) were due to sample inadequacy, 1.35% (3,282) to early sampling (<48 h), and 1.97% (4,801) to abnormal results. Of all recalls, 80.9% were received following the initial request, 1,679 (19.1%) required special efforts. Of these, 873 were achieved following a single and 601 following repeated central activities, and 102 were achieved following local support. Sixty-three cases of parental refusal and 47 untraceable children remained. Altogether, 98.8% recalls were achieved, corresponding to 99.96% of all tested children for which definite screening results could be obtained. CONCLUSIONS: Expansion of newborn screening programs does not necessarily mean unsolvable problems in tracking of recalls if adequate logistics is established in parallel.

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PubMed2002

[Result-oriented remuneration for hospital inpatient care].

Fee-for-benefit means the adjustment of the reimbursement at the quality of care. Both a bonus and a penalty are possible. It is suggested to measure innovative therapies with outcome parameters and give a bonus as an incentive for quality improvements. Standard therapies should be measured with process parameters and be sanctioned with a penalty when the standards are missed. To determine the extend of the bonus and the penalty, the variable costs of a hospital could be used as a reference. Therefore a penalty should not exceed approximately 25 % of the reimbursement. The costs for the introduction and administration of the fee-for-benefit reimbursement must be seen in the context of the necessary improvement of quality insurance in per-case reimbursement with DRG (Diagnosis-Related Groups) in Germany. Related to the incidence of preventable adverse events and the additional costs of poor-quality outcome evaluated from studies fee-for-benefit will be cost-effective by avoiding every sixth adverse event. German legislation allows fee-for-benefit only in small model projects or local integrated networks. It is recommended to allow an optional opening of negotiations between hospitals and sickness funds for fee-for-benefit elements. A pilot study should evaluate the incidence and cost of preventable adverse events in Germany.

Germany↗