Funding of early rehabilitation

After passing the bill for a new prospective reimbursement system, Germany is now approaching the introduction of the DRG-system taken over from Australia. Experiences from the USA and Australia show a lot of consequences for all those involved. There are uncertainties right from the beginning, especially concerning the point where acute care meets subordinate care. Payment systems for comprehensive early rehabilitation in acute care have to be developed. The existing DRG-system does not reflect these rehabilitation services as it is only orientated to ICD-10. The development of funding systems in rehabilitation has to take into account, health consequences and individual rehabilitation needs. The registration of functional health, according to the International Classification of Functioning, Disability and Health seems to be an adequate basis. To proceed the payment system there are only two alternatives. First, rehabilitation services are integrated in the DRG-system. Second, rehabilitation services are paid in a different way. The major issue is establishing a good predictor of length of stay, need for rehabilitation and use of resources. This explains why rehabilitation is less determined by the underlying diagnoses as by decreased body function, activity and participation. A concept with clear and standardized criteria for early rehabilitation will distinguish between acute care determined by DRGs and non-acute care. The regulation in funding of DRG based acute care and subordinate services is of major importance and has to be solved soon for early rehabilitation services. There has to be a guarantee that a payment system covers necessary rehabilitation services throughout the whole duration of acute, sub-acute and none-acute care.