The planned reform by Health Minister Karl Lauterbach (59, SPD) should result in millions of hospital treatments being saved. Because they are done on an outpatient basis – or are omitted entirely.
Reinhard Busse, Professor of Health Care Management (TU Berlin) explains: “Based on the fact that we are 50 percent above the level of our neighboring countries, this involves several million cases that are treated as outpatients or are completely eliminated.” it’s not just about operations, so buses to BILD.
Chemotherapy for cancer is also unnecessarily often treated as an inpatient in Germany: On average, cancer patients in Germany are hospitalized four times (and often not even in specialized clinics). In neighboring countries, cancer patients are hospitalized only twice on average.
The reason for the German excess of hospital treatments: the case-based system. The more treatments, the more money the hospital makes. This is not always in the best interest of the patient.
What can Lauterbach’s reform actually bring?
In 2021, 16.7 million cases were treated in German hospitals. The number of beds was 483,606, but only 68 percent of them were occupied.
The complaint of the clinics: They are overloaded because there are not enough staff. And the problem could only get worse, because with the baby boomer generation more doctors and nurses are retiring than young professionals.
Fewer treatments, fewer clinics
The antidote of the hospital commission, to which Prof. Busse belongs: If the hospitals only treat as many inpatient cases as is really necessary, then the burden on the staff will decrease.
With provision flat rates, i.e. a budget for the stand-by mode (similar to that of the fire brigade), the hospitals should still get their full budget.
The Commission proposes dividing the hospitals into newly defined levels. The lowest level (“Level 1 i”) will continue to be called a hospital, but will actually be converted into an outpatient-inpatient center. Means: Only acute cases come to the hospital bed there, under nursing supervision. The rest is done on an outpatient basis. Busse refers to the example of Denmark, which operates rural hospitals without any beds.
According to Busse, a large part of the approximately 1,700 hospital locations in Germany fall into this category. “It is questionable whether all of these will be preserved, especially in urban areas,” he says. “Your need is particularly in rural areas. ‘Real’ hospitals with better technology and staffing (currently there are only 425 in Emergency Level 3 and 2, equivalent to our Levels III and II) will increase rather than decrease.”