Qualitätssicherung bei der sozialmedizinischen Sachaufklärung in der Deutschen Rentenversicherung

Abstract

The systematic quality assurance (QA) is an essential element of every medical work. Therefore QA is also compulsory for all socio-medical tasks in the statutory pension insurance in Germany. The medical advisors employed in the pension insurance are involved in nearly all cases of administrative procedures in connection with applications for medical or vocational rehabilitation and for benefits for reduction in earning capacity. It is necessary to confirm whether the medical condition for this performance or benefit is fulfilled or not. The socio-medical assessment is executed by a medical estimate with a personal examination and questioning by the medical advisor, but also by a medical estimate based on the presented documents. The medical advisor is only an advisor, but his advice is very important for the position of points in the current administrative procedure. Therefore, the responsibility of the medical doctors is very high, due to the financial dimensions behind this medical advice. The costs of benefits for reduction in earning capacity average 120,000 euro. The cost for occupational or vocational rehabilitation often achieve the same level, a medical rehabilitation costs the pension insurance nearly 3,000 euro for three weeks, but very often also much more. Thus it is very important for both the applicant and also the pension insurance, that all doctors apply equal standards. It must not depend on luck or bad luck whether a submitted pension or performance is granted or not. Therefore different medical guidelines have been established in order to prevent unequal results.