PubMed · 11609487
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E Hickel. 1972. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11609487/
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BACKGROUND: The relationship between reimbursement for medical care and the quality of medicine is mostly discussed if there are warnings about underuse as a consequence of underpayment. By various examples it can be illustrated that not only a lack of services but also an overuse of medical care may be hazardous and reduce quality in medicine. This relates to the risk, which is part of each medical intervention. PRESENT SITUATION: The introduction of the Diagnosis Related Groups (DRGs) in Germany is at present mostly discussed under the aspect of a possible risk of underuse. On the other hand, there are chances for the quality of medicine as a result from a lean diagnostic and therapy, which will be the consequence of economic changes induced by the DRGs. A guideline-oriented medicine will often avoid unnecessary procedures and thereby improve the quality of medical services. CONCLUSION: Loss of quality and improvement of quality arise in the field of medicine from overuse as well as from underuse. Most important for an optimal quality is a quantitatively appropriate treatment. In general, we observe that medical decisions are more and more oriented on economic frames. It has to be observed during forthcoming years to what extent ethical problems arise by this situation.
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Major organ transplant today is to be regarded as an established therapeutic procedure for treating irreversible organ failure. The creation of the necessary technological, immunological and ethical foundations in the 20th century brought about a true breakthrough in transplantation medicine. The presentation outlines various clinical pictures that can lead to chronic organ failure based on examples of heart, liver and kidney diseases. The long-term survival rates of patients/transplants are outlined and a comparison of international statistics drawn. Different problems that can arise in connection with a transplant, e.g. rejection reactions or transplant arteriosclerosis, are also broached. The heterogeneous risk profiles of the immunosuppressant drugs that the transplant recipient must take for the rest of his life are also discussed at length. There is no doubt about the fact that major organ transplants constitute a challenge to insurance medicine. The extreme extramortality of transplant recipients in the initial postoperative phase, makes immediate acceptance of transplant recipient applicants for life insurance prohibitive. It is, however, possible today to accept liver or kidney transplant recipients who have experienced a favourable post-transplant course, with adequate postponement. Finally, the presentation touches upon the different focuses of science's attempts to counteract a growing shortage of organs.