Minister of Health Lauterbach once again promoted his planned hospital reform at the German Doctors’ Conference. However, some of the key points in the healthcare system also raise significant concerns.
Time is running out for the Federal Ministry of Health: it wants to present the cornerstones for the planned hospital reform by the summer recess of the Bundestag. Department head Karl Lauterbach once again vigorously promoted the planned measures at the start of the German Doctors’ Day. But his plans only partially met with a positive response.
The reform is urgently needed – and has actually been for years, emphasized the Minister of Health in Essen. Around 250 representatives from the medical and health sector will come together here on the 127th Doctors’ Day until Friday.
The SPD politician hopes that the reform will improve the quality of care for patients – and that combined with less bureaucracy for health care workers. And above all, Lauterbach once again put the “de-economy” of the healthcare system in Essen.
provision services instead of flat rates
This should work primarily by moving away from the case flat rates, which clinics charge per patient treated. With this type of compensation, hospitals would only have the choice of doing more treatments or making the treatments cheaper, Lauterbach warned. “It can’t be a good system.”
Instead, the reform plans provide for significantly more so-called reserve services. Fixed contributions are to flow to the hospitals for personnel or for the necessary technology.
Furthermore, clinics are to be divided by means of the reform: into categories and service groups. On the one hand, there should be facilities in the categories that serve the local basic needs of the population. Level two are clinics for “regular and specialized care” with additional services, and then there should be hospitals for “maximum care”, such as university clinics.
The division into the so-called service groups is intended to ensure that only those clinics that have the necessary specialist departments, i.e. are technically equipped for the respective treatment and employ the specialized staff, can bill for certain treatments.
Criticism of the three-tier system
But Klaus Reinhardt, President of the German Doctors’ Association, criticizes the planned division of the clinics into three stages. Although he does support the specialization of individual hospitals in certain fields, he said in the joint morning magazine ARD and ZDF. But he rejects a “rigid division” into basic providers, specialized houses and maximum providers. Instead, the existing structures would have to be further developed.
On the other hand, praise comes from the President of the Doctors for the desired end of the case flat rates. Lauterbach is thus fulfilling a requirement that doctors have been making for a long time.
Laumann shows up willing to compromise
North Rhine-Westphalia’s Minister of Health, Karl-Josef Laumann, also adopted a defused tone in the debate about hospital reform at the Doctors’ Day. It is crucial that in the end “the quality and accessibility of the health system in all regions” is ensured, he said. “I think we both have a responsibility that the hospitals can then deal with what we’re doing there.”
In the past, Laumann was one of the harshest critics of Lauterbach’s plans. Also against the background that North Rhine-Westphalia was striving for a state-owned hospital reform. He also questioned the legality of a nationwide reform, since hospital planning is a matter for the individual federal states. Together with Bavaria and Schleswig-Holstein, NRW therefore commissioned a legal opinion that basically confirmed the concerns of the states.
But at the end of March, the states and the federal government came closer again in the dispute over the reform. The traffic light coalition realized that it shouldn’t intervene too much in state competences, Laumann said at the time.
“No test laboratories for immature technology”
But not only the federal states should be involved in the reorganization of the hospitals, stressed Medical President Reinhardt. The stakeholders in the healthcare system should also be heard more when implementing political projects.
The concerns of health care workers must also be taken into account, for example on the subject of digitization. The industry is open to that. But many doctors are frustrated because the technology is not stable. “Politics and industry should be clear that medical practices and clinics are not test laboratories for immature technology,” emphasized Reinhardt.
Patients must be able to handle e-files
Reinhardt also sees a need to catch up when it comes to digital patient files. The federal government plans that all those with statutory health insurance will automatically receive an e-file by the end of 2024 – unless you actively refuse to do so. So far, you have to actively consent if you want one.
The prerequisite for this is that patients can control the data in their own files themselves and easily object to their use. In addition, Reinhardt demanded that the electronic patient record be used to make decisions about the release of one’s own data for research purposes in an uncomplicated way.
Always more challenges at health protection
For Reinhardt, health protection is facing ever more diverse challenges. At the start of the Doctors’ Day, he emphasized that health had to be considered when considering numerous social issues, from school and family to urban planning.
Reinhardt cited climate change as a problem – in the form of heat waves, for example. This requires appropriate action plans, structural changes and education from the healthcare industry. Furthermore, Reinhardt warned of a growing risk of older people being isolated in society and becoming ill.
But caring for refugees – who often suffer from psychological stress as well as physical consequences – poses a challenge for the health care system.