[Are there technological advances in minimally invasive surgery and who will pay them?]. / Gibt es technologische Fortschritte in der MIC und wer soll das bezahlen?

The successful development of minimally invasive surgery would have been inconceivable without continuous advances in medical technology. The users, i.e. the surgeons, however, only accepted innovations with a clear-cut positive impact on clinical care. Accordingly, the expected exponential rise in costs could be avoided. The imbalance in cost/benefit aspects between the deliverers of medical care on one hand, and the patients, the insurance companies and the employers on the other is critical. In addition, further innovations are to be expected. This will not be possible without increasing costs, but there are good reasons to assume that expenses will rise only moderately. Each modern society is able (and obliged) to afford a certain amount of medical progress in order to maintain a high level of medical care and economic strength.

[Clinic communication and disease-oriented centers]. / Klinikkommunikation und krankheitsorientierte Zentren.

German hospitals and surgical clinics/departments are facing far-reaching changes. One triggering factor is the imminent reorganization of hospital financing to a system of compensation, which is universally based on diagnosis-related groups (DRGs) and entails a market-economy orientation in the hospital sector. Digital technologies, which facilitate making the necessary adjustments to clinic structures to meet forthcoming challenges, represent another element. The "digital transformation" of the hospital of the future takes place on three levels. The restructuring of the surgical realm runs rather a traditional course by increasing use of information technology, mostly to optimize documentation and existing procedures or to reduce costs. The second sphere reaches substantially further, encompassing reorganization of disease-oriented cooperation between the different medical specialties and enabling the establishment of suitably structured disease-oriented medical centers. This is followed by the third phase, which involves networking clinics or medical centers with private practitioners, aftercare and rehabilitation services, and other disease-oriented care providers.

[DRGs in surgery from the viewpoint of a clinic]. / DRGs in der Chirurgie aus Sicht eines Klinikums.

Because of the significance that documentation has in order for the first DRG budget to be drafted in 2003, priority has to be given in all surgical departments to assuring that codification is of a very high standard. Clinical management and senior surgeons will have to develop strategies which enable them to maintain patient care, a range of services, and efficiency in their surgical departments. Defining and concentrating on core competences and the value chain in surgery will be of increasing importance in their ability to assert themselves in future. The introduction of the DRG system will give new value to the surgeon's role in modern departments and in clinical management.

[Consultation and liaison activity from the socioeconomic perspective. A plea for cost-benefit analysis in psychosomatics]. / Konsiliar-/Liaison-Tätigkeit aus der sozioökonomischen Perspektive. Ein Plädoyer für Kosten-Ergebnis-Analysen in der Psychosomatik.

Within the last decade cost-effectiveness assumes a much more strategic perspective in the rationing of care that is taking place due to evidently increasingly limited financial resources and managed-care driven protocols. As universities and general hospitals face this increasing pressure to justify services within their facilities, consultation-liaison (C/L) programs need to carefully address and evaluate the financial base of the services they provide. Overlooking or neglecting the financial aspects of C/L-services has already resulted in the closure or service reduction of C/L-programs throughout the United States. Whereas a result of that development interest in cost-effectiveness research is considerable in the US and GB and has produced some good evidence for the impact of psychosocial problems on the outcome and cost of medical care, nearly no such studies come from the German-speaking countries. The present article reviews the worldwide existing literature concerning cost-effectiveness analyses of C/L-work and attempts to guide the reader through the currently available methods for cost-effectiveness research. As a conclusion we propose somatisation syndromes as one patient group. There the development of appropriate treatment regiments is vital both concerning clinical and socioeconomical aspects.