Newly developed, already licensed, high-priced medical devices for critically ill patients impose additional costs especially on the hospital sector. In countries with a DRG-based reimbursement system there are no economic incentives for hospitals to use the new technologies as long as the additional cost are not compensated. OBJECTIVES: The objective of this paper is to analyse the structures of the German health care system which are involved in the implementation of new high-priced medical technologies the hospital sector in the reimbursement system and to determine key factors of a successful implementation. METHODS: The institutions involved in the determination of the catalogue of reimbursed items based on the just newly introduced German DRG-system are described and examined. Illustrated by examples the launching of newly emerging medical devices for inpatient treatment is analysed. Investigated parameters were the number and quality of studies published, the involvement of health technology assessment institutions, the adjustment of the reimbursement system in a time frame allowing the survival of the company, and the dissemination of the technology. RESULTS: Involvement of objective institutions like the Federal Committee (GemBA) or the Institute for Reimbursement in the hospital sector (INEK) is necessary to prevent implementation of new technologies without adequate medical efficacy and economic effectiveness. For positive recommendations a critical mass of clinical and health economic studies is prerequisite. But in time adjustment of the reimbursement catalogue, e.g. as new DRG or additional payment to existing DRGs, seem to be crucial for implementation of a new costly technology. CONCLUSION: Slow decision processes can delay if not prevent the use of useful new therapeutic technologies. Although according to the German law cost effectiveness should be considered in reimbursement decisions, so far it did not play a relevant role in reimbursement decisions in the hospital sector.