Federal Minister of Health Karl Lauterbach presented the plans for a reform of hospital care on Tuesday. “From my point of view, a revolution in the system,” announced the SPD politician at the federal press conference in Berlin. He promised a detachment from the flat-rate reimbursement in hospitals.
The current problems in the children’s wards are only examples of a fundamental financing problem, Lauterbach justified the decision. “If I always get the same money on the case, it’s worth it if I treat it cheaper.” This means a trend towards cheaper medicine and an incentive for more and more treatments. Savings are made in obstetrics and on children and youth wards, but too much is often done for people at the end of their lives. The system puts hospitals in a “hamster wheel” and the problem is unique in Europe.
The reform is based on three pillars: On the one hand, people should be able to rely on the fact that hospitals, especially in rural areas, will remain open regardless of the number of cases if they are necessary to care for patients. According to a commission of experts, a “provisional benefit” should be paid for this, i.e. the clinics are partly paid for their existence.
Second: “Medicine is being put back in the foreground and is not following the economy,” said Lauterbach. Patients would therefore be treated in the way that makes the most medical sense, not in the most economical way. To this end, clinics are to work more closely with resident doctors in the future, thereby promoting outpatient treatment.
Thirdly, in the future, special interventions should be performed where they could be performed particularly well, i.e. hospitals should specialize more.
This “in my opinion, a revolution in the hospital sector that we absolutely need” should also lead to an improvement in the staffing situation in hospitals. Many specialists left the clinics because they could not bear the economic pressure. “Otherwise we won’t be able to take care of the baby boomers,” warned Lauterbach.
Christian Karagiannidis went on to explain that the reserve capacity can be compared to that of the fire brigade. The President of the German Society for Internal Intensive Care Medicine and Emergency Medicine (DGIIN) had worked on the reform proposals as a member of an expert commission. “Perhaps the golden mean” of this reserve service and a fee per case is being considered, because a certain economic incentive remains necessary. The proposal provides for 40 percent coverage of general costs and 60 percent for intensive care medicine.
“We have made mistakes on all sides in the past 20 years,” said the doctor Karagiannidis self-critically. “I very much hope that today will be a turning point.” It is something “special that we were able to make free scientific decisions. We didn’t have any political guidelines,” he emphasized.
Commission coordinator Tom Bschor said he does not expect the reform to increase costs for the healthcare system. Fewer unnecessary treatments and fewer inpatient admissions would probably offset the additional expenses, the psychiatrist said.
Last week, the Bundestag had already passed some new regulations to relieve the burden on nursing staff and children’s clinics. Among other things, patients in the clinics should be treated more on an outpatient basis and stay less overnight. These resolutions addressed the most pressing problems, said Lauterbach – but the reform now presented should fix the fundamental problem.
Unlike in the case of outpatient medical treatment, the level of hospital reimbursement has so far not depended on the individual services rendered. It was based on the diagnoses treated. There was a catalog of diagnosis-related case flat rates. Lauterbach saw more disadvantages than advantages in this. Areas in which no profit could be made would be disadvantaged.
The reform proposals were drawn up by a government commission set up in May. Their coordinator Tom Bschor also attended the press conference, as did the President of the German Society for Internal Intensive Care Medicine and Emergency Medicine (DGIIN), Christian Karagiannidis, and the Deputy Chairwoman of the Supervisory Board of the Berlin Charité, Irmtraud Gürkan.
