HNO-Begutachtung im MDK Nordrhein Ein Beitrag zur internen Diskussion über die quantitative und qualitative Optimierung eines Begutachtungsprozesses.
Traduction en anglais : ENT medical Expertising for statutory sickness insurance.
Contribution to an Internal Discussion on Quantitative and Qualitative Optimisation of Expertising Procedures : The medical advisory and expertising Services of the German statutory sickness insurance are according to German social legislation authorised to request supporting documents direct from the treating physicians or hospitals.
The consultant medical expertiser for ENT diseases at Cologne worked out the percentage of requests that resulted in, further investigations and the amount of work involved.
A document form was used to record all such requests for a given period. 154 expertising procedures concerning ENT diseases were counted within a period of 5 weeks. 47% of the patients concerned pertained to workers'sickness insurance funds and 29% to guilds sickness insurance funds.
Two thirds of all requests were channelled through the statutory sociomedical preconsultant service and one-third were sent by post. 55% of all the requested documents were considered to be, complete « and 45% »incomplete .
N=100 requests were initial and N=54 were follow-up requests.
The answers received were considered satisfactory and final in 62% of the requests, whereas, further inquiries were considered necessary in n=58 (38%) of the cases. 80% of the cases in which the requests resulted in satisfactory information, were approved for sickness insurance payment and approximately 20% were rejected. (...)
Mots-clés Pascal : Allemagne, Europe, Système santé, Organisation santé, Protection sociale, Assurance maladie, Qualité, Recommandation, Expertise médicale
Mots-clés Pascal anglais : Germany, Europe, Health system, Public health organization, Welfare aids, Health insurance, Quality, Recommendation, Medical expertise
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0269722
Code Inist : 002B30A01B. Création : 16/11/1999.