Although chronic diseases build the main focus of health problems, the German health care system is not sufficiently prepared to deal with the new challenges. The reasons are diverse, but one of the most decisive is that the various consequences in dealing with chronic disease are scarcely noticed by the health service. These consequences are brought out by the following article by referring to the available literature and our own studies and are discussed in its implications for a needs-driven design of care. Special attention is paid to care, because it increasingly assumes a key role in the treatment of chronically ill, which still faces barriers in this country. These discussed are also.