[Chances for advancement of outpatient rehabilitation in Germany].
Rehabilitation has a long tradition in Germany compared to other countries and is based upon a differentiated, social law foundation. Rehabilitative offers are provided as standard benefits by different social insurance schemes (pension insurance, health insurance, accident insurance, etc.) and are an independent task of care not included in acute care. A high degree of institutionalisation and specialisation are specific characteristics of rehabilitation in Germany. A country-wide network of indication specific, mostly larger institutions is available for medical rehabilitation in Germany. This emergence of centres and the location of many institutions in more rural regions give rise to the fact that rehabilitation often cannot take place close to the places of residence of those who are in need of rehabilitative offers. Until the mid-nineties, rehabilitative benefits have been performed almost exclusively on an inpatient basis, which is another characteristic of medical rehabilitation in Germany. Since then the discussion about ambulant rehabilitation has been increasing. Several initiatives are aimed at supplementing the present in-patient offers through ambulant measures. This article describes and analyses the present efforts for the development of ambulant rehabilitation. In reference to the guidelines of the BAR (Federal Rehabilitation Council) concerning ambulant medical rehabilitation, adopted by all institutions involved in 2000, the current situation and the state of implementation are discussed, and advancements necessary in the authors' view are considered.
Institut für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf. koch@uke.uni-hamburg.de.
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D000553:Ambulatory Care / Q000458:organization & administration*; D005544:Forecasting; D005858:Germany; D006284:Health Plan Implementation / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration; D009313:National Health Programs / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D012046:Rehabilitation / Q000458:organization & administration*; D012047:Rehabilitation Centers / Q000458:organization & administration*