Abstract
In 2008 the German statutory pension insurance handled about 1 600 000 applications for medical rehabilitation. The overall approval rate was 70%, with a range between 60 and 86% in regional pension insurances. The majority of applications were refused on the ground that ambulatory medical or psychotherapeutic treatment was sufficient. Physicians frequently argued that ambulatory psychotherapy was unavailable due to long waiting lists or lack of psychotherapists. The problem whether shortcomings in ambulatory care can constitute sufficient reason to affirm a need for inpatient rehabilitation is discussed. It is necessary to improve the basis for needs assessment by the medical services (e. g. personal assessment, contacting family doctors). A survey of the further development (e. g. course of disease, disability days, and early retirement) of insurees whose applications for rehabilitation were rejected is recommended.
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