[New forms of remuneration and care delivery: their impact on rehabilitation]. / Neue Vergütungs- und Versorgungsformen und ihre Auswirkungen auf die Rehabilitation.

Current health policy reform efforts in Germany include introduction of a DRG (Diagnosis Related Group) based funding system in the hospital sector as well as integrated delivery of health care and disease management programs, developments that will directly affect the medical rehabilitation sector. Decreasing lengths of hospital stay induced by the DRG system will inter alia entail a shifting of cases and costs to subsequent sectors. Moreover, hospitals might not least seek compensation for shorter hospital stays by extending their scope to include rehabilitation and long-term care services. Introduction of the DRG system in acute-hospital care has resulted in major changes in respect of early rehabilitation. Existing specialized early rehabilitation facilities providing high-quality care face serious funding problems on account of the newly introduced early rehabilitation DRGs. For hospitals previously not involved in early rehabilitation on the other hand, incentives arise to set up new early rehabilitation structures although the need for these additional capacities obviously is questionable. Introduction of the DRG-based funding system has reinforced the discussion about applying a flat-rate system also in the rehabilitation sector. This form of remuneration however is inappropriate to medical rehabilitation concepts. On the other hand, a remuneration system incorporating cross-institutional per-diem fees and "treatment time" budgets might enable using essential advantages of flat-rate payment without having to expect repercussions for the quality of care. In the context of integrated care and disease management programs the issue at stake for rehabilitation primarily is to be able to contribute its specific competencies appropriately. Also, integrated health care is bound to result in stronger competition among the various health care sectors. If rehabilitation is set to face this competition, further research efforts will urgently have to be made along with ongoing development of clinical practice guidelines.

[Current status and progress in scientific rehabilitation research]. / Stand und Entwicklung der rehabilitationswissenschaftlichen Forschung.

When compared to the entire field of health research, to the significance and role of rehabilitation in the health care system, to future developments in demand and to international developments, the field of rehabilitation in Germany has formerly suffered from a considerable deficit in research regarding both structure and content. The German Federal Ministry of Research and the German Statutory Pension Insurance have now established a common focus in research. This decision reflects not only a new political attitude toward the promotion of research but also represents the initiation of attempts to overcome existing research deficits permanently by means of an extensive programme for the promotion of research. In addition to the construction of a scientific infrastructure, the funders most importantly expect results that will contribute to the further optimisation of effectiveness and efficiency in rehabilitation services. An improved scientific foundation of rehabilitative practice will also assist the field of rehabilitation in finding greater socio-political recognition as an interdisciplinary field. In order to achieve the demanding goals of this promotion of research, the promoters will accompany the programme with efficient scientific management and quality assurance. The statutory pension insurance institutes will systematically analyse the expected research results and offer recommendations and suggestions for realisation in dialogue with scientific experts and specialist practitioners.

[Rehabilitation from the economic viewpoint in relation to the legal social security insurance]. / Rehabilitation unter ökonomischen Gesichtspunkten aus der Sicht der gesetzlichen Rentenversicherung.

Rehabilitation increasingly focuses on patients' chronic diseases and a restricted efficiency in job and everyday life. In Germany, the specialized rehabilitation system has been adapted to this development and produced particular successful, holistic, and interdisciplinary concepts which involve medical, occupational, and social benefits. Medical rehabilitation as a field discipline and treatment method has been advanced continuously and can not be compared with acute or curative care. During recent years rehabilitation expenses increased constantly; however, the cost increase corresponds to the rise of the actual need. The share of all rehabilitation expenses (rehabilitation providers, types of benefit) in health care benefits is between 6% and 7% and consequently considerably lower than hospital charges, for example. Economy in rehabilitation, as it now is especially intended through a restrictive rehabilitation benefit budgeting for the statutory pension insurance, will not reduce health care expenses in all. On the one hand, it is to be expected that benefits for pensions and care will rise in the medium term. On the other hand, economy in rehabilitation will produce additional expenses in other health care sectors without being more effective. Since the need for rehabilitation benefits will further increase due to demographic development, new priorities should be set in favor of patients with chronic diseases.