14 Herfarth SurgeryJuly 2003

is presently trying to introduce a nearly national-ized health system in Germany, starting with freez-ing annual budgets (for at least 2 to 3 years) andrestricting patients’ choice of physician. The fur-ther development of privately financed medicine(15% until now) remains unclear. The collective

wage system hitherto in use could be changed. Inmany ways, the future is open and uncertain.

REFERENCES1. Herfarth C. “Lean” surgery through changes in surgical

workflow. Br J Surg 2003;90:513-4.