It should be Lauterbach’s masterpiece – and a “revolution in the hospital sector”. But the Federal Minister of Health needs the federal states for his reform plans. Can he convince her today?
Karl Lauterbach is certainly not a minister of small words. He announced a “revolution in the hospital sector” in December. “A revolution that we absolutely need,” said Lauterbach.
Hardly anyone would disagree with him. The system is considered expensive, dilapidated and inefficient: the diagnosis shared by many experts is that there are too many clinics that eat up a third of the health insurance company’s budget. And patients do not get the best possible care everywhere.
However, it is the case that for a revolution you generally need comrades-in-arms. It could be seen today whether the Federal Minister of Health has them by his side. In what is probably the decisive round before the summer break, Lauterbach is struggling with the federal states for a key issues paper in order to at least get his revolution off the ground.
A power struggle
Tough rounds of negotiations lie behind the SPD politician. A power struggle has broken out between him and the countries that do not want to be interfered with when planning the hospital. The three Union-led states of Bavaria, North Rhine-Westphalia and Schleswig-Holstein had a legal opinion certified in April that Lauterbach’s plans went too far and violated the legislative competence of the states.
But displeasure has also spread in countries with green or social democratic health ministers.
The details of the reform are complicated and the debate is emotional. The Federal Minister of Health has now moved away from the goal of presenting a draft law together with the federal states by the summer break. Some countries are even stepping on the brakes when it comes to the key issues paper.
Less cost pressure
There is agreement with the federal states to reorganize the financing of the hospitals. Lauterbach wants to reduce the economic pressure in the clinics. The good care of the patients should come more to the fore. The federal government should therefore pay less per case treated via the health insurance companies. There should be more money for the fixed costs of the clinics, for example for having enough staff, technology or emergency rooms.
But there is a dispute because Lauterbach wants to sharpen nationwide quality criteria for clinics. He has already severely reduced his original plans due to the protests from the countries. But his goal remains the same: concentrate and improve care. Small hospitals should only be able to offer and bill for treatments for which they are qualified. He has science on his side. Because it has been proven that more patients die in small houses than in tumor centers after cancer operations.
What will become of small clinics in the countryside?
But above all the non-city states fear for their small clinics in the countryside. If the reform comes, they could no longer offer certain interventions. If they want to survive, they would have to develop into a kind of supply centers. They would then only offer minor outpatient surgeries and take care of minor emergencies such as broken arms. They would probably no longer be hospitals in the classic sense.
For him it is important that the people in the rural areas are well and qualitatively cared for and that care is not a privilege of the metropolis, Bavaria’s Minister of Health Klaus Holetschek repeats again and again. With the upcoming state elections in Bavaria in October, the CSU politician has made a name for himself as an opponent of Lauterbach in Berlin. Other countries are less vocal in their protest. But whether an agreement can be reached this week is questionable.
The details of the cornerstones, including transitional periods until the reform is implemented and exemptions for the federal states, are being wrestled with. Among other things, this passage in the draft key points from the Federal Ministry of Health is causing a stir: countries should also be allowed to assign so-called performance groups such as cardiology to hospitals if they do not meet all the quality criteria. But only if this is necessary to ensure the supply.
This means that no other hospital in the region could match it. For this, the states would have to obtain “approval” from the federal government. This should be limited to a period of two years.
Bavaria wants “legroom”
Significant resistance to this comes promptly from Bavaria. A federal veto is out of the question, says Holetschek. The countries need “legroom” to ensure supply in the area. Specifically, the Bavarian Minister of Health fears that the requirements for small hospitals will be too strict, for example a large number of intensive care beds.
Lauterbach also plans to make the quality of the clinics transparent for patients and to publish it. With an interactive map, he wants to show everyone clearly and simply which clinics meet the standards and which do not. The countries are up in arms against this “transparency offensive”. They fear for the reputation of their small hospitals, even if that seems less understandable from the patient’s point of view.
99 minutes to the clinic?
The countries have a point when it comes to their concern for nationwide coverage in the countryside. In fact, urban areas tend to be oversupplied. In rural areas, on the other hand, there are also regions where the journey to the nearest clinic with basic emergency care can take up to 99 minutes.
Intensive care physician Christian Karagiannidis, a member of the federal government’s hospital commission, is therefore calling for a reform of the rescue service at the same time. “We have to concentrate very hard on being able to reach the rural regions easily, especially by helicopter, during the day, but also at night,” says Karagiannidis. This is part of the hospital reform.
merger of clinics
But while Lauterbach’s reform is progressing slowly, the clinics are already sounding the alarm. Gerald Gass from the German Hospital Society warns that every fourth hospital is threatened with insolvency. 80 percent would already be in the red today.
This also includes the hospital in Pinneberg near Hamburg. But here they are already planning what Lauterbach wants to implement for the whole country, namely more efficient structures and better quality for the patients. The clinic is to be merged with the hospital in Elmshorn, 15 kilometers away. They expect from a new, larger clinic: more interventions bundled in one house and thus more routine.
Hamid Mofid, the medical director, is also concerned with making better use of scarce human resources. In this respect, Pinneberg and Elmshorn are in the process of proactively preparing for the future. Without money, however, this will not succeed. Managing director Regina Hein expects 500 million euros for the merger. A sum that the state of Schleswig-Holstein simply cannot afford on the side, she says. Whether and to what extent the federal government will contribute to such costs as part of the hospital reform is one of the many open questions.
Here the traffic light is unanimous
It is therefore a difficult situation in which Lauterbach is fighting for his revolution, the hospital reform. He can be sure of the support of the traffic light factions. Because even if the traffic light parties are currently at odds on many issues: it’s different with the hospital reform.
“We stand united behind the reform,” says health politician Christine Aschenberg-Dugnus from the FDP. The countries’ current blockade is an attack on patient welfare and sustainable care, she says. Constructive cooperation is expected for today so that the cornerstones can be further developed into a draft law over the summer.
The health policy spokesman for the Greens, Janosch Dahmen, sounds similar. The traffic light factions agreed that an effective hospital reform was urgently needed. On the one hand, to ensure the economic existence of the hospitals, which have themselves become patients. On the other hand, to reduce the high workload on staff and to improve the quality of patient care. A reform must keep the promise that patients in rural areas as well as in the city can rely on getting to the right hospital in the right place and at the right time, says Dahmen.
It doesn’t work without countries
But it does not seem unlikely that the federal and state governments will not be able to settle all the points of contention today. It would then be conceivable for the federal government to develop a draft law over the summer, if necessary without common key points with the federal states.
In the end, however, it all comes down to the states as comrades-in-arms and their approval in the Bundesrat. With its “revolution in the hospital sector”, the states of Lauterbach could still put a spanner in the works.