Quality and Cost Management

In healthcare, a variety of different measures and instruments can be applied to manage both the quality and the costs at the same time. The following chapter will discuss the usefulness and effectiveness of applying specific instruments for quality and cost management. In gatekeeping, most treatment episodes begin with a visit to an individually selected physician, the gatekeeper, who ensures a coordinated and cross-sectorial treatment process. Guidelines are used to standardise the provision of medical services and form the basis of clinical pathways, which coordinate the stages of the treatment throughout the different areas of care as efficiently as possible. Formularies are used to explicitly define which services are paid for, whereas the utilisation review is a case-by-case assessment of the services provided. Disease management, on the other hand, coordinates the care of patients suffering from a specific disease beyond the care provided by an individual service provider. In case management each individual patient’s treatment is coordinated and evaluated across the different sectors. Differing from the methods mentioned before is demand management, which is used to directing the patients’ utilisation of medical services. Besides limiting the demand for discretionary services, patient coaching aims at increasing the patients’ self-competence. Ultimately, quality management is applied to increase the quality of the healthcare provision.