[Managed care--a model also for ambulatory medical care in Germany?].

Rising expenditure of health care has caused industrialized nations to change the structure of their health care systems. The goal is to achieve high quality of care at low cost. Managed care (MC)--most prevalent in the United States--plays an important role in the current discussion in Europe. This concept which provides different ways of financing and organization aims to improve the direction and control of health care delivery. Usually, a family physician takes the role of a gatekeeper by offering access to all parts of medical care. This kind of health care system seems to be associated with lower expenditure and a better state of health. Some negative developments in the USA--partly dissatisfaction of patients and physicians as well as refusal or delay of medical care--must not necessarily take place in other countries. With a critical approach to managed care, Germany may take the opportunity of adapting positive elements of MC to its health care system and avoid problems of the US system. Although the basis for testing MC-models has been created by the health care reform act in 1997, these opportunities have not been adequately taken up.