Using routine data collected in 2000 for the quality assurance programme of the German Pension Insurance subjective mental impairment and disorders documented in discharge letters of patients undergoing rehabilitation funded by the Federal Insurance Institute for Salaried Employees (BfA) (n = 19,272) were correlated with psychological treatment and inpatient somato-medical rehabilitation provided. The results show discrepancies between self-evaluation, original diagnosis and treatment received. The frequency of treatments varies between hospitals. The differences in treatment are attributed rather to a varying quality of implementation of the bio-psycho-social concept than to a lack of human resources.

lung und Rehabilitation in der Psychoso− matischen Medizin und Psychotherapie wird kontrovers diskutiert. Die beteilig− ten Parteien, die eigentlich als Partner ein gemeinsames Anliegen vertreten soll− ten, haben zum Teil sehr unterschiedli− che Auffassungen und Vorstellungen zu stationärer Psychotherapie. Vor allem die Leistungserbringer in dem System, die Krankenhäuser und die Rehaeinrich− tungen, tragen konkurrierende Stand− punkte vor. Es stellt sich die Frage, ob sie einander dadurch nicht mehr behin− dern als fördern, in einem Gesundheits− markt, dessen wesentliches Entschei− dungskriterium in den Auseinanderset− zungen mit Kostenträgern und Politik die Erfüllung der Anforderungen an klini− sche Qualität und zugleich Ökonomie ge− worden ist. Es ist nicht zu übersehen, dass sich in dem Verhältnis von Kranken− haus und Rehabilitation in der Psycho− therapie erhebliche Probleme aufgetürmt haben, die einer Lösung bedürfen. Dazu müssen auch die Kosten− bzw. Leistungs− träger in die Pflicht genommen werden, denen gerne pauschal unterstellt wird, zulasten der Behandlungsqualität nur sparen zu wollen, die aber auch gerne pauschal argumentieren, es werde un− wirtschaftlich zu viel Geld ausgegeben. Entsprechend werden Kürzungen vorge− nommen oder es wird die Notwendigkeit der Kostenübernahme von stationärer Krankenhausbehandlung über die Medi− zinischen Dienste bestritten und vor die Sozialgerichte getragen.

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in chronic obstructive pulmonary diseases (COPD) and bronchial asthma were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e. g. for the assessment of applications for decreased earning capacity benefits. Part II outlines assessment of the individual's capacity, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.

Medical rehabilitation is an important part of the German health care system in addition to medical and nursing care. For people with impairments, especially with chronic diseases, rehabilitation aims at emancipated participation in social life. The German pension insurance carries out rehabilitation mainly for gainfully employed people. To be entitled to these benefits legal and personal (medical) requirements must be fulfilled. The rehabilitation concepts of the German pension insurance are interdisciplinary, following the bio-psycho-social model of health and illness. Concepts of rehabilitation are presented exemplarily for musculoskeletal, oncologic, heart/circulation, metabolic/gastrointestinal, and neurological diseases as well as mental disorders. Elements of structure, process, and outcome quality are illustrated. Research topics in rehabilitation are presented.