Als 2003 die DRG (Fallpauschalen) eingeführt worden sind, lag der Fokus auf den größeren Krankenhäusern, auf die rund 90 Prozent der Krankenhauskosten entfallen. Die kleineren Häuser auf dem Land hatten niedrige Tagessätze und auch die Fallzahlen waren dort kein Problem. Mit Einführung der DRGs wurden die kleinen Häuser allerdings über Nacht unwirtschaftlich und zu einem Kollateralschaden der DRG-Einführung.
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