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Background In 2003 Germany started to replace its per-day hospital payment system by a prospective payment system based on diagnosis related groups (DRG). The primary objective of the program was to increase economic efficiency of hospital care. The introduction was accompanied by fears that quality of care could deteriorate when hospitals withhold necessary care in order to increase profits. Outpatient physicians expected an increase in their workload, which could probably lead to financial losses if it were not followed by an increase of their reimbursement. In order to detect possible adverse effects, the Statutory Health Insurance (SHI) was obligated by law to commission independent observational research on this question.

Does the implementation of a new payment system for hospital services induce changes in the quality of health care? Experiences from Germany