Diagnosis-related groups (DRGs) are an instrument for classification of inpatient cases. DRGs are finding ever broader implementation internationally. Targets for using DRGs are hospital financing and budgeting, cost accounting and quality assurance. The present survey covering 18 countries shows that so far DRGs are most frequently used for budgeting purposes. In addition to DRG-based reimbursement, further quality assurance is necessary, but this is only being implemented with hesitation. The coverage planned for all inpatient cases through DRG-based reimbursement in Germany from 2003 on is a pioneering challenge internationally.