With a new reimbursement system, the Minister of Health wants to ensure that patients are treated more frequently on an outpatient basis or go home at night. After heavy criticism, he now wants to pay midwives better.
Fewer overnight stays in the hospital, more outpatient operations: Federal Health Minister Karl Lauterbach (SPD) wants to use a new remuneration system to make inpatient stays in the hospital less attractive and thus save money. “We want to save patients the hospital stays and at the same time relieve the staff there,” said Lauterbach Rheinische Post. “We are converting the system in such a way that unnecessary hospital admissions for simple procedures will no longer be worthwhile in the future.”
Lauterbach’s complaint has been around for a long time: “The proportion of inpatient treatments here is still far too high by international standards.” That’s why he wants many treatments that used to be in a clinic to be carried out on an outpatient basis in the future. “And even for inpatients, the overnight stay is not necessary if the patient wishes it and there is nothing medically opposed to it,” said the minister. In the future, patients should therefore be able to choose whether they prefer to go home for the night or stay in the clinic – and decide on this together with the doctor. “The overnight stay in the hospital is not necessarily part of good medicine,” says the physician Lauterbach.
In October he had already discussed this with his colleagues from the countries. In Germany there are 50 percent more inpatient admissions than in the surrounding countries, without this improving the quality of care, he said at the time. “That’s a big reserve.”
After criticism, Lauterbach backtracked on midwife payment
For treatments, the clinics receive so-called flat rates from the health insurance companies – i.e. fixed payments per patient, depending on the diagnosis. Critics have long complained that this system is an incentive for hospitals to increase the number of profitable operations and to reduce departments that tend to make a loss, such as pediatric and adolescent medicine or obstetrics. Lauterbach wants to take countermeasures in these areas with his reform of the reimbursement system: “Obstetrics and paediatrics must not be subject to the austerity dictates of the old hospital system.” In a first step, they should receive surcharges on top of the case-based flat rates.
Lauterbach also turns around on a point that has recently drawn a lot of criticism: midwives should remain in the so-called care budget. “And we will take the midwives out of the case-based flat-rate system and pay for their services separately,” he said Rheinische Post – the SPD had also demanded this in the Bundestag election campaign in 2021. “The economic pressure is not compatible with the job profile. In the future, hospitals should no longer be able to save on the backs of midwives,” said Lauterbach. His original plans met with fierce opposition. The German Association of Midwives said they had “catastrophic effects on clinical obstetrics”. Lauterbach has now responded to this.