The German Association for Ambulatory Surgery called Bundesverband für Ambulantes Operieren (BAO) has recently had some noticeable success:
The only official resistance to perform more Ambulatory Surgery in Germany came from the German Hospital Association (Deutsche Krankenhausgesellschaft DKG). The probable reason is that remuneration for Ambulatory Surgery in hospitals and day clinics alike is only 25% of the corresponding inpatient DRG. So hospitals make four times more money with conventional inpatient treatment than with Ambulatory Surgery. As prices for procedures for the Statutory Health Insurance Fund (GKV) which serves 90% of the German population are set by governmental agencies the Federal Governmentx can either pass a new law or admit higher prices for Ambulatory Surgery.
The Federal Government which since September 2009 consists of a coalition government of conservatives and liberals is presently working on a Healthcare Reform Act. The problem of remuneration of Ambulatory Surgery probably will be tackled by this upcoming reform by the end of this year.
The German Government certainly is in a dilemma: It does neither want to introduce nationalized medicine nor to shift to a free market system. But the European Union requires either nationalized medicine or a free market system. Germany so far has lived with a mixture of nationalized and free market medicine called the system of self-government (Selbstverwaltung). But it will be forced to give up self-government sooner or later.