[Competition between physicians and hospitals--are hospitals the big winners?].

Competition and cooperation are contradictory aspects of economic systems; in the healthcare system they also govern the process of creation and distribution of value. Both are needed to reach higher levels of efficiency and innovation. Regarding competition as a universal remedy which only has to be applied in higher doses in order to cure the multiple illnesses of the healthcare sector is a single-sided view and does not match economic reality.

[Extended medical services to the inpatient sector--"medical services on individual demand" in the hospital. General legal conditions, 10 basic rules, and practical examples].

Today, extended medical services--previously known in the context of ambulant healthcare provision or plastic surgery only--are increasingly being offered by hospitals. Hospitals have started to offer these services with good reason: in times of budgetary restraints they want to exploit this emerging new market due to economic necessities and they try to meet rising demands from patients. It is not easy to draw the line between special (extended) medical services and general hospital services.

[Taking stock after 400 days--healthcare centres from a medical point of view].

At the beginning of 2004 the legislator introduced a new organisational form of ambulatory care into the German healthcare system, the so-called "Medizinische Versorgungszentrum" (MVZ; ambulatory healthcare centre). For the first time, hospitals are admitted to the sector of ambulatory healthcare (apart from the provision of emergency services). Naturally, this causes a great deal of conflict between the traditional health service providers (doctors in private practice) and their professional associations, looking at the new entities rather suspiciously since these can lay claim to a substantial portion of the budgeted reimbursement in this healthcare sector.

[Allocation of resources and restrictive standards in hospitals in the face of economic and personnel shortages].

The allocation of financial resources between both hospitals and the departments within a single hospital follows historically grown structures. Concepts on the basis of well-established factors for the systematic allocation of resources are rarely if ever used. Systematic approaches are needed, especially in times of decreasing resources, but they have to be grounded in a detailed understanding of both the customers and the products offered.

[Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the point of view of the hospital owners].

Structural changes in the financing of hospital-based health care in Germany make a revision of the currently existing strict separation between ambulatory and stationary patient care inevitable. The present monopolist situation of office-based physicians (organised in private practices without any legal or financial relation to a hospital) will be amended by the participation of hospitals and hospital-employed doctors in ambulatory services of a different kind. These may include the institutional authorization of hospitals to participate in ambulatory services, especially in the case of emergencies and first aid, and co-operations between doctors in private practices and hospitals.