Im Beitrag werden wesentliche Herausforderungen denen Ärzte als Berufsgruppe aktuell gegenüberstehen aufgezeigt und in Bezug auf ihre Auswirkungen hinsichtlich des traditionellen ärztlichen Berufsbildes diskutiert. Ärzte können dabei als Angehörige einer geradezu klassischen Profession betrachtet werden. So werden im Beitrag allgemeine professionsspezifische Merkmale, wie z.B. die Anwendung hochspezifischen Wissens, der hohe Autonomiegrad in Bezug auf die Durchführung der eigenen Tätigkeit oder die Orientierung an einem „Berufsethos“, auf Ärzte übertragen und spezifiziert. Anschließend werden Herausforderungen in Form 1) der Entwicklung zur Wissens- und Informationsgesellschaft, 2) des demographischen Wandels in Deutschland und insbesondere 3) die aktuellen Tendenzen einer neuen politischen Steuerungslogik von Gesundheitsleistungen erläutert. Dann wird aufgezeigt, dass diese Tendenzen in vielerlei Hinsicht eine Bedrohung für das traditionelle professionelle Berufsbild des Arztes darstellen, indem etwa eine Aushöhlung des ärztlichen Wissensbestandes wahrgenommen werden kann oder die bisherigen Standards des ärztlichen Arbeitsvollzuges hinterfragt werden. Diese Bedrohung äußert sich dabei u.a. in konkreten Handlungskonflikten, denen Ärzte in ihrer alltäglichen Berufspraxis, d.h. im täglichen Umgang mit Patienten, gegenüberstehen. Insofern behandelt der Beitrag zugleich mögliche Auswirkungen auf den ärztlichen Arbeitsvollzug und die Erbringung von Gesundheitsleistungen. Der Fokus richtet sich dabei insbesondere auf die ärztliche Praxis in Krankenhäusern. Letztlich wird hervorgehoben, dass Erkenntnisse über Professionen, professionelle Handlungsmuster und die damit zusammenhänge Steuerungslogik professioneller Leistungen in sogenannten „professionellen“ oder „bürokratisch-professionellen“ Organisationen von genereller Wichtigkeit sind, um die aktuell ablaufenden Veränderungsprozesse in medizinischen Einrichtungen analysierbar und in ihrer sozialen Dynamik als auch ihrer Ergebnisse interpretierbar zu machen. / The paper shows that German hospital clinicians are faced with crucial challenges to their professional self-understanding nowadays. For this, clinicians are introduced as professionals by explaining specific characteristics of their occupation, like the knowledge intense activity or the high grade of work autonomy. Further the papers explains that the present challenges express conflicts between the traditional occupational orientation of clinicians and new expectations referring to the manner of clinical work. Three main challenges are to identify 1) the development of a knowledge intensive society, with growing possibilities to get information about disease diagnosis and therapy 2) the demographic change and 3) the partly corresponding changes in the political steering of public health services. The paper points out, that these developments threat traditional professional orientations as they lead to a socially perceived hollowing out of medical knowledge and a change of professional standards of medical performance. It is to highlight that these conflicts cannot only get separated as subjective or psychological problem of clinicians. Moreover these conflicts influence the concrete treatment of patients in hospitals. In this way, the paper delivers insights to analyse, understand and judge present change contents and change dynamics in „professional organizations” and „bureauprofessional organizations”.

Individual decision-making and the generation of medical demand are crucial subjects in healthcare economics. The following scientific discussion can be classified into these threads. The demand for health care services is typically connected to characteristic imperfections reflecting a bias between an objective and a subjective assessment of a specific demand situation or externally caused frictions. For that reason, the realized demand is not necessarily connected to an efficient allocation of resources. Hence, it is a crucial objective to analyze individual decision-making related on the one hand to specific treatment alternatives and on the other hand to the specified decision framework. This framework is characterized by both the attributes of the individual as well as by the external conditions in which the decision takes place. Theirby, the analysis focuses specifically on potential sources of demand inefficiency and their effectiveness. The following discussion broach the issue of two significant objectives within health economics: 1. Trade in medical care and patient migration, 2. Patient autonomy and education. Both fields find their analytical basis in a micro-economic discussion of individual decision behavior. The first field analyzes the decision between medical provision at home or abroad. This subject is specifically related to a potential efficiency gain due to the existence of cross-border price and quality gradients, usually a source of gains in trade. In the focus of the analysis is the impact of the specific characteristics of these gradients as determinants of cross-border medical demand. The second field discusses the investment decision in measures of patient education and prevention in a framework of a common consultation and self-care as imperfect treatment alternatives due to imperfect competences of self-diagnosis and medical self-supply. This subject is related to the commonly acknowledged positive correlation between health and education. Education is able to improve the quality of health production and, therefore, has a specific impact with respect to increasing autonomous behavior of the individual in issues of health production. The specific environment of these decisions significantly influences the mechanism of decision-making and the final outcome; this must be assessed according to the effect on the allocative efficiency of medical demand. The role of price and quality gradients between alternatives, the differentiation of illnesses, as well as subjective factors, are crucial to the results. Moreover, the individual's ability to appraise his or her own health stock and demand decisions is itself risky. Therefore, the form of the insurance coverage is another important element when analyzing individual decisions. The following discussion will clarify the decision-making mechanisms and their impact on efficient resource allocation. Since the focus is on demand behavior, the interaction with, and therefore the behavior of, the supply side is not explicitly formulated.

Im Beitrag werden wesentliche Herausforderungen denen Ärzte als Berufsgruppe aktuell gegenüberstehen aufgezeigt und in Bezug auf ihre Auswirkungen hinsichtlich des traditionellen ärztlichen Berufsbildes diskutiert. Ärzte können dabei als Angehörige einer geradezu klassischen Profession betrachtet werden. So werden im Beitrag allgemeine professionsspezifische Merkmale, wie z.B. die Anwendung hochspezifischen Wissens, der hohe Autonomiegrad in Bezug auf die Durchführung der eigenen Tätigkeit oder die Orientierung an einem „Berufsethos“, auf Ärzte übertragen und spezifiziert. Anschließend werden Herausforderungen in Form 1) der Entwicklung zur Wissens- und Informationsgesellschaft, 2) des demographischen Wandels in Deutschland und insbesondere 3) die aktuellen Tendenzen einer neuen politischen Steuerungslogik von Gesundheitsleistungen erläutert. Dann wird aufgezeigt, dass diese Tendenzen in vielerlei Hinsicht eine Bedrohung für das traditionelle professionelle Berufsbild des Arztes darstellen, indem etwa eine Aushöhlung des ärztlichen Wissensbestandes wahrgenommen werden kann oder die bisherigen Standards des ärztlichen Arbeitsvollzuges hinterfragt werden. Diese Bedrohung äußert sich dabei u.a. in konkreten Handlungskonflikten, denen Ärzte in ihrer alltäglichen Berufspraxis, d.h. im täglichen Umgang mit Patienten, gegenüberstehen. Insofern behandelt der Beitrag zugleich mögliche Auswirkungen auf den ärztlichen Arbeitsvollzug und die Erbringung von Gesundheitsleistungen. Der Fokus richtet sich dabei insbesondere auf die ärztliche Praxis in Krankenhäusern. Letztlich wird hervorgehoben, dass Erkenntnisse über Professionen, professionelle Handlungsmuster und die damit zusammenhänge Steuerungslogik professioneller Leistungen in sogenannten „professionellen“ oder „bürokratisch-professionellen“ Organisationen von genereller Wichtigkeit sind, um die aktuell ablaufenden Veränderungsprozesse in medizinischen Einrichtungen analysierbar und in ihrer sozialen Dynamik als auch ihrer Ergebnisse interpretierbar zu machen. / The paper shows that German hospital clinicians are faced with crucial challenges to their professional self-understanding nowadays. For this, clinicians are introduced as professionals by explaining specific characteristics of their occupation, like the knowledge intense activity or the high grade of work autonomy. Further the papers explains that the present challenges express conflicts between the traditional occupational orientation of clinicians and new expectations referring to the manner of clinical work. Three main challenges are to identify 1) the development of a knowledge intensive society, with growing possibilities to get information about disease diagnosis and therapy 2) the demographic change and 3) the partly corresponding changes in the political steering of public health services. The paper points out, that these developments threat traditional professional orientations as they lead to a socially perceived hollowing out of medical knowledge and a change of professional standards of medical performance. It is to highlight that these conflicts cannot only get separated as subjective or psychological problem of clinicians. Moreover these conflicts influence the concrete treatment of patients in hospitals. In this way, the paper delivers insights to analyse, understand and judge present change contents and change dynamics in „professional organizations” and „bureauprofessional organizations”.

Individual decision-making and the generation of medical demand are crucial subjects in healthcare economics. The following scientific discussion can be classified into these threads. The demand for health care services is typically connected to characteristic imperfections reflecting a bias between an objective and a subjective assessment of a specific demand situation or externally caused frictions. For that reason, the realized demand is not necessarily connected to an efficient allocation of resources. Hence, it is a crucial objective to analyze individual decision-making related on the one hand to specific treatment alternatives and on the other hand to the specified decision framework. This framework is characterized by both the attributes of the individual as well as by the external conditions in which the decision takes place. Theirby, the analysis focuses specifically on potential sources of demand inefficiency and their effectiveness. The following discussion broach the issue of two significant objectives within health economics: 1. Trade in medical care and patient migration, 2. Patient autonomy and education. Both fields find their analytical basis in a micro-economic discussion of individual decision behavior. The first field analyzes the decision between medical provision at home or abroad. This subject is specifically related to a potential efficiency gain due to the existence of cross-border price and quality gradients, usually a source of gains in trade. In the focus of the analysis is the impact of the specific characteristics of these gradients as determinants of cross-border medical demand. The second field discusses the investment decision in measures of patient education and prevention in a framework of a common consultation and self-care as imperfect treatment alternatives due to imperfect competences of self-diagnosis and medical self-supply. This subject is related to the commonly acknowledged positive correlation between health and education. Education is able to improve the quality of health production and, therefore, has a specific impact with respect to increasing autonomous behavior of the individual in issues of health production. The specific environment of these decisions significantly influences the mechanism of decision-making and the final outcome; this must be assessed according to the effect on the allocative efficiency of medical demand. The role of price and quality gradients between alternatives, the differentiation of illnesses, as well as subjective factors, are crucial to the results. Moreover, the individual's ability to appraise his or her own health stock and demand decisions is itself risky. Therefore, the form of the insurance coverage is another important element when analyzing individual decisions. The following discussion will clarify the decision-making mechanisms and their impact on efficient resource allocation. Since the focus is on demand behavior, the interaction with, and therefore the behavior of, the supply side is not explicitly formulated.