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Germany is facing a dilemma in the field of out-of-hospital intensive care because at present it looks as if health insurance companies will no longer have to cover the costs of basic care for the seriously ill. Instead, basic care services will probably have to be borne by the local authorities. The costs for this are then estimated at 1.5 billion euros per year. Further burdens on the local authorities will be added because the health insurance companies have insisted that these people should no longer be cared for in clinical intensive care units but in nursing homes. However, this has led to nationwide protests, because those affected and their relatives refused to give their consent and are now nursing 20,000 serious cases at home in their own four walls. The out-of-hospital intensive care saves health insurance companies one-third of all costs that would otherwise be incurred. The savings are the result of restrictions on the health insurance companies‘ service areas, the basis being a law introduced by the German government, namely the Intensive Care and Rehabilitation Strengthening Act, or IPReG for short. The gaps in care that have arisen are now being closed by the municipalities, which, due to the shortage of skilled workers in rural areas, have to fall back on so-called nursing assistants who work together with relatives and laypersons who perform heavy work. As a result of the new regulation, the nursing assistants will in future be paid by the social welfare offices of the municipalities, which will burden the municipalities again with around 600 to 750 million euros. The GKV will only have to pay for certified nursing specialists, according to the new regulation, which does not exist, however, due to the lack of specialists, especially in rural structures. Health insurance companies were previously obliged to cover and pay for the care needs of seriously ill patients. Now, however, they can decide independently via the Federal Joint Committee which services in the non-clinical intensive care sector are covered.