Influenced by the economic situation in the health service, the German social insurance institute for pensions (GRV) was the first to implement an external quality assurance programme (QAP) for inpatient medical rehabilitation. On the basis of the results obtained and the instruments developed, the German National Health insurance association (GKV) and German statutory accident insurance association (GUV) built up their own external quality assurance programmes, adding instruments which they had deve loped for “their” medical rehabilitation. Structural quality is checked by recording the quality and quantity of the rooms, medical-technological equipment and personnel and so called structure-related features. The process quality is mainly assessed in a peer review procedure on the basis of the final medical report and the therapeutic measures used (checked off a list from a catalogue of therapeutic interventions [KTL]). The quality of the results is monitored differently by the different social insurance institutions. They all ask the patients about the measures used and whether they were satisfied with their rehabilitation, but with different questionnaires. The German federal pension insurance institute for employees (BfA), part of the GRV, also monitors work history for a period of two years after the rehabilitation, the GKV includes an additional physican’s questionnaire for pre-rehabilitation and post-rehabilitation status, the GUV uses their own approved physician (“D-Arzt”) as an additional external assessor. For further validation of the results of the quality assurance programme, the GKV visits rehabilitation clinics, and also performs a risk adjustment to ensure that the comparison of clinics is fair. The critics of these external quality control programmes discuss mainly the relationship between effort and results, the difficulties in benchmarking clinics and the applicability of the indicators chosen for everyday medical rehabilitation and its improvement.
