In recent years, under the pressure of necessary reforms, a process of consolidation in the hospital sector had already been evident. Between 1991 and 2003 bed capacity fell by almost a fifth and the number of hospitals by 9 % - although the number of hospital cases rose by almost one-fifth. The average hospital stay declined from 14 to just under 9 days. Despite this enhanced performance, patients in Germany spend longer in hospital than in other countries such as Austria (8.1 days), USA (6.6) and Denmark (5.7). This has much to do with the fact that hospital remuneration is largely linked to the length of hospital stay.