Is hospital reform enough? | tagesschau.de

As of: October 13, 2024 12:18 p.m

Too few staff, too few medications, too little money. The federal government’s planned hospital reform is intended to help German clinics. But is that enough? And what would it take to really make hospitals future-proof?

Anke Hahn (RBB)

Heyo Kroemer is really angry when he thinks about Stern and RTL’s research at the Berlin Charité. Undercover Journalists had researched and filmedto uncover grievances in one of the largest university hospitals in Europe. They highlighted staffing shortages in patient care and training of medical students who were left alone in the emergency department without more experienced colleagues.

The head of the Charité complains that the shooting crossed borders and endangered patients’ lives. The reports were also “incomplete, exaggerated and incorrect”. Legal action is being considered. However, Kroemer admitted in a hearing by the Berlin House of Representatives on the occasion of the reports, there is definitely a lot that needs to be improved. But this doesn’t just affect the Charité, but all hospitals across Germany. Because the situation is actually bad – everywhere.

This assessment is shared by everyone who is concerned with the situation in hospitals. Things cannot continue as they are, say employees, health insurance companies, scientists and politicians. That is why the federal government is working on a hospital reform law that is intended to remedy this situation.

The basic ideas: fewer hospitals, better organization, different financing. And fundamentally these are steps in the right direction; there is also great agreement on this. But it gets difficult in the details. As with the question, is this reform even enough to fundamentally improve something?

Germany has too many hospitals

It is now undisputed that Germany has too many hospitals for the available financial resources. There isn’t enough money for everyone. Clinics are constantly being closed or facing bankruptcy. Many are only kept alive by their municipalities or districts with permanent subsidies. There are two options to change that: more money for existing hospitals or fewer hospitals. Except for the hospital operators, everyone else is in favor of reducing the number of clinics.

On the one hand, because a lot of money is already being spent on inpatient treatment – those with statutory health insurance alone paid 94 billion euros last year, which corresponds to almost a third of all statutory health insurance expenditure.

On the other hand, because there are too many beds across Germany. “The utilization rate is just 70 percent,” says Reinhard Busse from the TU Berlin. Many beds are empty, cost money without services, and tie up staff who are needed elsewhere. “The shortage of skilled workers in nursing is nonsense,” he points out. If nursing staff and doctors were deployed in fewer but better equipped clinics, there would be no shortage. After Ireland and Finland, Germany has the highest number of nursing staff per capita in Europe. That should actually be enough.

Resistance from the federal states

Such a reduction in clinics is actually planned for in the Hospital Reform Act. But resistance to this is forming in the federal states. You want to determine which locations will be preserved. And it is becoming apparent: Hardly any state government dares to close clinics in their state. On the contrary, state health ministers keep promising: We will maintain all hospital locations.

Because the protest is enormous when a hospital is supposed to be closed. People fear long journeys to the next clinic, communities worry about their attractiveness if they don’t even have a hospital for their population.

This is simply a mistake in thinking, says Hartmut Reiners, health economist and journalist. “Proximity to a hospital means nothing if it is not sufficiently efficient.” If the clinic around the corner doesn’t have any equipment for heart attacks or strokes, it’s of no use to those affected. Or a delivery room without an attached children’s ward. He suggests that it would be better to travel longer to a real clinic in specially equipped ambulances and then receive good care.

Because people would actually gain something if there were fewer but better hospitals, say experts like Reiners and Busse. The quality of treatment is currently not sufficient in many hospitals. This needs to be communicated better by the respective state politicians instead of always fueling people’s fears in a populist manner.

Better combining outpatient and inpatient care

In any case, experts are calling for a fundamental change to the structures in the healthcare system. The strict separation between inpatient and outpatient care is expensive and pointless. In Germany, too many people are being treated as inpatients for whom it is not necessary. “Patients are put to bed after treatment because that’s the only way it makes sense for the hospitals. But nothing else actually happens,” explains Busse. Conversely, there is a lack of staff in outpatient care who are tied up in hospitals. So that the outpatient practices are overloaded and patients are forced into the hospital.

But experts fear that this historically grown problem would be difficult to reform if each area only saw its own interests. Everyone always points to the other as having to change something first. Doctors in private practice feel overburdened and hospitals are underfunded. The federal government only half-heartedly planned changes here.

Only with the reform of emergency care are outpatient practices in clinics planned, which are intended to relieve the burden on emergency services. But there is also criticism from resident doctors who say they have no capacity for additional tasks.

Too little money and wrongly financed

And the question of sufficient financing remains. In any case, this is above all the federal government’s reform plans. The hospital reform, for example, plans a different form of hospital financing system. The flat rates used so far, i.e. fixed payments for treatments based on their number, are to be supplemented by a so-called reserve fee. The clinics then receive money for generally offering certain services.

That was the idea of ​​the experts who developed the reform proposals for the Federal Ministry of Health. Reinhard Busse was one of them, as was Wolfgang Greiner from Bielefeld University. They are now criticizing the fact that there is a risk of the principle being weakened in the negotiations with the countries. It’s more about the quantities delivered instead of the actual needs.

But for Greiner, the biggest problem is that, in his opinion, the change in the hospital landscape is being financed incorrectly. The planned transformation fund is not sufficient at 50 billion euros for ten years. Double that is necessary. He also criticizes the fact that half of the money in the fund should come from those with statutory health insurance. Structural change is a task for society as a whole and not part of health insurance. The health insurance companies would have a good chance if they took these plans to court. But that is a big problem because it would further delay the reform, which is already coming too late.

That wouldn’t be good news for Heyo Kroemer and the Charité either. Because if there are shortages everywhere, even in a clinic as renowned and comparatively well-equipped as the Charité, then a reform is not only necessary, but needed quickly. Everyone agrees on that.

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