Rationalisation or rationing — ways out of the ever increasing dilemma?

Abstract

In Germany, the sectors of outpatient treatment and inpatient treatment are strictly segregated. There are admittedly demands from all sides to recognise integrated care as a possible provisional solution to the problems, but in my opinion the outpatient/inpatient interlinking is far from being as successful as this would require, i.e. there are insufficient incentives to transfer services between sectors. The hospital is forced for budgetary reasons to retain as far as possible all the services it provided previously, even if these could long ago have been provided on an outpatient basis. The outpatient area does not receive sufficient financial incentives to want to provide services from the inpatient sector in an ambulatory form.