Health
Lauterbach: Clinic reform is coming – Clinic Atlas from May 1st
Karl Lauterbach: “The hospital reform is back on track.” photo
© Kay Nietfeld/dpa
Selection of the most experienced clinics via online check, fewer deaths through specialization: The Minister of Health is making big promises about his hospital reform.
From May 1st, patients in Germany should be able to choose the most suitable hospitals online before undergoing hospital treatment. Federal Minister of Health Karl Lauterbach (SPD) announced that the corresponding clinical atlas should then be launched.
This is to be followed by the planned major clinical reform, which the federal and state governments have been struggling with for months. “Hospital reform is back on track,” said Lauterbach. Reactions to his announcements were mixed.
The clinic atlas is intended to provide information right from the start about how much experience a clinic has with certain procedures – such as cancer treatment. Lauterbach was confident that the corresponding transparency law could be passed in the Federal Council on March 22nd. On February 21st, the Mediation Committee of the Bundesrat and Bundestag will negotiate the regulations. The majority of the state chamber initially rejected it.
Lauterbach expects movement among hospital patients
“I am very grateful that the Union-led countries have given up their blockade stance,” said Lauterbach. The SPD politician had accused these countries of not putting the draft law on the agenda of the mediation committee. “Of course the transparency law is unreasonable for some countries,” he told the “Stuttgarter Nachrichten”, the “Stuttgarter Zeitung” and the newspaper of the Neue Berliner Editorial Society. The big differences in quality would be shown, for example in cancer surgery or in the care of heart patients. This will bring movement to the question of where patients can be treated.
Clinic reform is due to go to cabinet in April
The more comprehensive clinic reform is to be passed in the federal cabinet on April 24th, as Lauterbach announced. Before that, it should be discussed again with the states. The day before, the states had put Lauterbach under pressure at the Health Ministers’ Conference to get the bill off the ground quickly.
The reform is intended to introduce a new payment method. Hospitals should then no longer treat as many patients as possible for reasons of revenue. Today, clinics receive a flat rate of euros per patient or treatment case. These per-case flat rates should be reduced. In return, there should be fixed amounts for the provision of staff, an emergency room or necessary medical technology.
Fewer deaths through specialization
“Major quality deficits” should be reduced through more specialization, said Lauterbach. Today, a third of cancer treatments are carried out in those two thirds of German clinics that do not understand this well due to a lack of experience. The result is: severe complications such as sepsis. A division into three levels should lead to greater specialization of some of the houses: clinics close to home for emergencies and basic care, houses with standard and specialized care and maximum providers such as university hospitals.
The Berlin health researcher Reinhard Busse supported Lauterbach with his own research results: A fatal outcome could be avoided in hundreds of patients with heart attacks, strokes or pneumonia if more of them were treated in the best clinics.
A new survey by the Techniker Krankenkasse signaled support for the specialization plans among the population: 94 percent of people in Germany would go to a specialized clinic for a planned operation – even if it is further away. 66 percent rated the reform goal of having complicated treatments carried out in specialized clinics as good, even if there are other options. A third rated this as bad.
“We have too many clinics”
According to Lauterbach’s forecast, the reform will significantly change the clinical landscape – some clinics, especially in major western German cities, will then be dismantled. “It is very clear that we have an oversupply of clinics,” said Lauterbach. In oversupplied cities, occupancy levels of only 50 to 70 percent are not uncommon. “We don’t have the staff for other facilities. That’s why we have too many clinics.” In the future, large medical care centers could replace clinics that are no longer needed.
At the same time, there are underserved areas in rural regions – clinics here should also be kept online through surcharges. Lauterbach did not want to speculate about the future number of clinics in Germany. According to the Federal Statistical Office, there were still 1,893 hospitals in 2022 – in 2001 there were around 2,200.
120 hospitals before or in bankruptcy
In the short term, billions in aid are intended to avert a wave of insolvencies among hospitals that are under severe financial pressure. “There are currently 120 hospitals before or in bankruptcy proceedings,” said Lauterbach. Six billion euros in aid should be launched with the Transparency Act. In addition, tariff increases should be offset. According to the German Hospital Society (DKG), almost 80 percent of hospitals in Germany were expecting a negative annual result last year.
Bavaria’s Health Minister Judith Gerlach (CSU) accused Lauterbach of preferring tactics rather than constructive negotiations. He surprisingly announced that the planned hospital reform should not require approval in the Federal Council.
The statutory health insurance companies, whose spending on hospital treatments had recently increased to around 88 billion euros in 2022, rejected more money for outdated structures. “If things are finally moving quickly towards more quality in patient care and less about the financial wishes of the clinics and the states, then it’s good,” said their association spokesman Florian Lanz.