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Prerequisites in prescribing practice: physician decision processes

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Selecting a drug for proper treatment of the patient is still primarily the physicians choice. The selection is usually not influenced beforehand but subject to control in a case of malpractice. It must be taken into consideration, however, that about half of the practising doctors in Germany are working in their own practice. The vast majority of these are participating in the statutory health insurance system. Their therapeutic measures have to be in accordance with the social code, it's by-laws, regulations and guidelines. Drugs may only be prescribed if a curable decrease has been determined and the range of potential prescriptions has been scrutinised. Two "negative lists" have to be observed. In addition to this, the prescription must be effective, sufficient and may not exceed the necessities. If there are therapeutic alternatives the drugs efficacy must be taken into evaluation. Since the beginning of 1993 the doctor's choice is also influenced by the overall budgeting of drug expenses and the fear of personal liability for a budget excess.