Effective by January 1, 1993, the Federal Care Rate Regulation (Bundespflegesatzverordnung; BPflV) has started increased competition between hospitals by introducing performance related reimbursements. All three categories of flat payments, Fallpauschale (FP), Sonderentgelt (SE) and Budget-patient (BP), apply to toxic nodular goiter surgery, governed solely by the extent of thyroid resection. Unlike FP 2.01 and FP 2.02 which do not cover all surgical expenses, the BP flat rate provides a comparatively generous refund for total thyroidectomy. With the oncoming reduction of upper values for residual radioactivity, hospitalization will fall after radioiodine therapy, resulting in lower overall refunds. With this anticipated fall in reimbursement, refunds for radioactive therapy must be increased in the near future to ensure adequate financial compensation. Economic arguments for either therapeutic option will then cease to play a major role, allowing medical therapeutic considerations to prevail.