ABSTRACT
The German health insurance system is characterized by a large number of different structural elements and levels of decision-making. Because no central political will has developed to achieve these aims, the process of agreement between the various levels of management and the various actors in the highly sectorized health insurance system is proving extremely difficult to begin. Even in areas where there is no current requirement for public-law regulation, that is, when test results are appended to a physician's referral letter, compulsory regulation by professional associations and federations or by the state would be required if new telecommunications technology were to be introduced. Pilot projects employing high-tech telecommunications applications have actually proved to be a barrier to the necessary process of agreement. When the electronic prescription is introduced, all the components of the telecommunications system must be made available to physicians' practices, pharmacies and hospitals.
