The AIDS initiative, one year later.
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The advantage of DMPs is that they can be used to define target criteria that are legally binding and thus allow for the control of core issues of our health care system. Legal security is to be established by evidence-based guidelines. At present, however, DMPs are still being dominated by economic aspects. From the point of view of the associations of statutory health insurance physicians, further criticism relates both to the transferral of highly sensitive data to health insurance funds and the remuneration for medical services in respect of DMPs. At least, extra-budgetary allotments are claimed after a transitional phase. And finally, the considerable administrative efforts involved are pointed out.
The health care systems in the Netherlands and the Federal Republic of Germany are based on a set of values that involve mutual obligations between private parties. These obligations are realized through systems incorporating private practice physicians, community and church- and municipality-affiliated hospitals, and nonprofit and for-profit insurers. The underlying values and implementation approaches in these systems provide an alternative to the adoption of a Canadian-style health insurance system. A discussion that focuses on "obligations" rather than "rights" may be a more useful approach for the design of reforms of the American health system in the 1990s. Such a discussion would focus on the mutual responsibility of all parties to create and maintain a universal private health care system.
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