The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 171
8.5.1.3 Financing
between the different sectors hampered the integration of hospital and ambulatory. The
Reform Act of SHI 2000, enhanced by reforms in 2002 and 2004, enabled (by means of
incentives) the implementation of models of integrated care.
See Appendix to chapter 8.
In 2000 the Australian system of diagnosis-related groups (DRGs) was adopted as the
basis for developing a German DRG hospital financing system. the development of a
DRG catalogue is seen as a starting point towards a more explicitly benefit catalogues
where all approved interventions are listed and grouped around the relevant diagnoses.
The Institute for the Payment System in Hospitals (InEK) is intended to support the
introduction and the further development of the DRG sys tem. The Institute defines the
DRG case groups, maintains the DRG system, and its severity classification system,
develops of a coding directive The Institute is also responsible for the calculation of
DRG cost weights and individual adjustments with in the DRG system.
A catalogue lists all procedures (services) performed in hospitals in accordance with
respective clinical diagnoses. The DRG system also constitutes the catalogue of services
and benefits covered by the SHI scheme for inpatient care. The inclusion of new health
care ser vices in the DRG system is made available at the beginning of each year. (based
on ICD 10)
• The German health care system shares decision-making powers between
the federal government, the individual states (Länder) and designated selfgovernmental
institutions. Responsibilities are delegated to membership
based, selfregulated institutions of payers and providers.
• All employees below a given income level must subscribe to an
independent not-for profit sickness fund. Individuals above that income
level have the right to opt out and arrange private coverage (a minority of
the population). The role of the sickness funds is publicly regulated.
• The sickness funds have a central role. Sickness funds contract for health
care services and negotiate prices, quantity and quality assurance
measures.
• Hospital care is outlined by federal legal framework. Planning and
regulation are done at Länder level, resulting in variation in offer among
the different Länder.
• The Australian system of diagnosis-related groups (DRGs) was adopted as
the basis for developing a German DRG hospital financing system.
8.5.2 The organisation of the Rehabilitation sector
8.5.2.1 The underlying conceptual ideas
Rehabilitation is defined as a multidisciplinary team approach adapting to the patient’s
needs. During the recovery period, these needs vary resulting in different goals in
different phases. A distinction is made between medical, vocational and social
rehabilitation.
Because of the historical formal segmentation between hospital care, rehabilitation care
and ambulatory care, delays or inconsistencies occur(ed) in the referral for further
rehabilitation. As mentioned earlier since 2000-2004 models of ‘Integrierte Versorgung
(integrated care model) ’were set up for heart failure and hip joint replacement. The
SHI, care providers and hospitals develop agreements to organise the full range of
services, from acute care to the completion of rehabilitation period 168 .