“The hospitals are not doing well.” With this diagnosis, Health Minister Karl Lauterbach (SPD) launched the presentation of the planned hospital reform on Tuesday morning. For a long time, the motto in many clinics was: quantity before quality. The so-called flat-rate system, which hospitals use to bill for their services, has systematically created false incentives: those who treat many lucrative cases also earn a lot of money. Savings were made in areas that are less worthwhile, such as pediatric medicine or nursing. That should change now. A new hospital reform is intended to help take the economic pressure off the clinics and improve patient care. Together with members of the “Government Commission for Modern and Needs-based Hospital Care”, Lauterbach presented three recommendations on Tuesday:
On the one hand, it should be uniform and clearly defined in the future hospital level give. Each clinic should be classified: Does it provide basic care (Level I), regular or specialized care (Level II) or maximum care (Level III), such as university clinics? Uniform standards for equipment, rooms and personnel apply to each level. A cancer patient, for example, should then only be treated in a hospital with certified oncology. Some federal states are already using similar levels, and the Minister of Health wants to standardize the system across Germany.
The Commission pays particular attention to first-level hospitals, which are the first point of contact for patients in rural areas and ensure basic care. In the new system, they are again divided into hospitals with and without an emergency room. The houses without emergency care are to be completely removed from the case-based flat-rate system and only be remunerated via daily flat-rates. There, patients could be treated more on an outpatient basis or after being transferred from a level II or III hospital. These hospitals do not necessarily have to be managed by doctors. Here, the Commission can also imagine management by qualified nursing staff.
The second point concerns the financing of hospitals. So far, this has only been done via the so-called flat rate per case: a fixed amount that is paid depending on the diagnosis. Clinics can charge a lot more for hip surgery than for monitoring a child who has fallen – even if it takes just as much time. In the future, therefore, so-called holding costs play a more important role, i.e. expenditure on personnel or equipment. This is comparable to a fire brigade, which is not constantly on duty, but can still intervene at any time, said Lauterbach. However, the flat rates per case should not disappear completely, they should only play a less important role. For example, they should only make up 40 percent in emergency medicine, and the remaining 60 percent should be covered by retention fees. This should relieve hospitals and, above all, less lucrative departments economically.
Third, it should be clearly defined in the clinics performance groups give. This means that specialist departments such as “internal medicine”, which were defined quite broadly, could in future be replaced by more precisely defined departments such as “cardiology”. If there is a cardiology department in a clinic, then this must also meet certain requirements. Many hospitals are currently treating certain cases without the necessary expertise, equipment or specialist staff, for example strokes without a so-called stroke unit or oncological diseases without a certified cancer center. In the future, treatments should only be billed if the hospital has been assigned the appropriate service group. The goal is to improve the quality of medical care.