Abstract
In Germany 90 % of the population is covered by a Statutory Health System (SHI) which claims to be one of the best in the world. Fees for procedures are budgeted, be they ambulatory or inpatient, in free standing units or in hospitals. As reimbursement for the same procedure is much higher as inpatient than as ambulatory treatment the system favors expensive inpatient treatment because of non-medical reasons.
Keywords: statutory health system, demographic factor, budgeting, ambulatory surgery