[Introduction of the flat rate reimbursement system in Germany : A historical review]

With the new millenium, "Gesundsheitsreform 2000" (Health Reform 2000) fundamentally changed the principles for reimbursement of hospital treatment costs in Germany. Before then, hospital treatment was completely reimbursed by the health insurance companies. Now, reimbursement is entirely based on a new diagnosis-related group (DRG) payment system. The aim was a reduction of the expanding cost of the health care system, more efficient economics, and better control. This concept was unique, since until now reimbursement had nowhere been based 100% on a DRG system. For critical care medicine, this became a special problem because standardization of treatment procedures is nearly impossible and is not related to specific diagnoses. Therefore, completely new solutions had to be found for a fair reimbursement of critical care treatment. The difficult search for a good solution is described here. The DIVI (German Interdisciplinary Association of Critical Care and Emergency Medicine) was able to present good arguments and concepts based on actual and realistic cost analyses. However, the solutions found remain insufficient, and fundamental problems are still not solved.