[Implementation of the public health reform law--experiences with diagnosis related case payment in surgery]

According to new German health care laws (Gesundheitsstrukturgesetz, Bundespflegesatzverordnung) hospital payment will be given a new basis. Abandoning the "length of stay"--related compensation in the future surgical services should be refunded either by special payments for a given surgical procedure (covering anesthesia, surgery, instruments), or by case-related payments (including all costs of stay, medical as well as room-and-care and administrative). This should lead to a more equitable payment getting a transparent insight into the relation service/cost. Calculations for the so far 103 special payment and 40 case related payment items have been obtained by a nationwide analysis in reference hospitals. Besides numerous problems introducing these new refund systems in very different hospital structures, our own 3-year experience using case related payment on our surgical department (based on individual calculation) shows promising results. The main intention still has to be--by setting free economic resources--to avoid rationing though rationalization.