The surgical university hospital: perspectives in the 21st century

University hospitals in Germany are undergoing deep structural changes. This is because of the severe cutbacks of resources and introduction of new remuneration systems. To be prepared for the future, university hospitals need new management structures, most of all new legal structures allowing free enterprise. A similar structural change is consequently necessary for surgical hospitals. They will have to be part of medically and/or functionally based centers and will have to overcome the problem of overspecialization by new organizational structure. Medical progress does not stop short at surgery. Surgery has to come to terms with the balancing act of laparoscopic/endoscopic surgery and open surgery. Here too, new organizational structures are required.