The major research initiatives in the Netherlands are located in UMCs with funding from the Ministries of Health and/or Education and Research and Science. Several institutes and groups conduct research in the field of pediatric psychosomatic medicine, including such topics as psychosocial outcomes following meningitis, gender identity disorders, quality of care, anorexia nervosa, morbid obesity, pain of unknown origin, and pediatric delirium.


Germany is a large industrialized country with 82 million inhabitants. Germany's health care system is almost entirely premium funded through compulsory health insurance. Physicians practicing in an outpatient setting are obligated to be members of the

Kassenärztliche Vereinigung, an association of statutory health insurance physicians that is mandated to guarantee adequate medical care for all insured patients. Payments are transferred from health insurance to the Kassenärztliche Vereinigung and then distributed to individual physicians. Reimbursement for inpatient care is negotiated between hospitals and insurance companies. For medical treatment, reimbursement rates are determined by diagnosis-related groups; for psychiatric treatment, reimbursement is based on number of hospital days.

In addition to the system of inpatient care for children and adolescents that focuses on acute illness and that of outpatient care that focuses on prevention, two other systems of pediatric care exist in Germany: 1) a nationwide network of inpatient rehabilitation facilities for children with chronic physical illness, with an average length of stay of 3-4 weeks, funded either by health insurance or by pension schemes, and 2) outpatient centers for social pediatrics established for the diagnosis and treatment of children with physical disabilities. Rehabilitation for children with chronic illness is funded not only by health insurance but also in part by the Federal Agency for Work, the Accident Insurance for Children in Kindergarten and Schools, the pension scheme, the law for compensation for victims of violence, the youth welfare system, and local social security.

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