[Basic considerations for increasing flexibility of services in medical rehabilitation]

Medical rehabilitation measures continue to be delivered nearly exclusively on an inpatient basis. A graded treatment concept comparable to those in place for instance in the acute or long-term care fields, is non-existent, while the medical need for a community-based ambulatory rehabilitation system is uncontested. Not least before a background of ever scacer financial resources among the rehabilitation agencies involved, non-inpatient rehabilitation has been gaining significance as it is generally hoped to achieve greater economy of service delivery. As a logical consequence, the demand for greater flexibility in delivering medical rehabilitation services and benefits is a focus of attention in the current rehabilitation policy debate. Greater flexibility in medical rehabilitation delivery means replacing portions of rehabilitation measures currently provided on an inpatient basis by partial-hospitalization or ambulatory service delivery; or continuing and complementing inpatient rehabilitation measures by non-inpatient ones; or using non-inpatient measures to provide aftercare post-discharge from inpatient rehabilitation. Moreover, ambulatory rehabilitation is intended to reach the population unamenable to attending far-away inpatient programmes. It is of utmost significance for the future evolution of ambulatory rehabilitation that the various financially responsible agencies involved in rehabilitation take a joint position on the subject of non-inpatient rehabilitation. Several proposals are submitted in this respect; for indications in the fields of neurology, orthopedics, cardiology, and geriatrics, catalogues of degrees of severity considered suitable for ambulatory rehabilitation are first presented.