Money is always too little everywhere, that’s no different in the German health care system, at least so far. One finds oneself, says Karl Lauterbach (SPD) on Thursday in Berlin, “on the eve of a necessary revolution”. The Federal Minister of Health means the hospital reform, which he has just spent hours discussing with the federal states – and at the end of which there should be a health system in which “medical aspects are more important again,” says Lauterbach. There is currently a healthcare system in which “the economic aspects completely dominate”.
In addition to the Federal Minister of Health, his counterparts Daniela Behrens (SPD) from Lower Saxony and Karl-Josef Laumann (CDU) from North Rhine-Westphalia also appeared before the press. Everyone is obviously trying to demonstrate a good mood. It was “a great session,” says Lauterbach. You can see that the federal government is proceeding “very cleverly” with this reform, says Behrens – after all, the federal states are involved in the development of the law from the beginning, which is by no means usual. Normally, the states only come into play at the very end of federal legislative projects.
Laumann also smiles, now and then he nods in agreement, but when it is the CDU man’s turn, he says almost casually: Constitutionally, by the way, hospital planning is “very clearly” a state matter. It has to stay that way. So that the states would get such strict guidelines from the federal government that they could no longer respond to regional differences, that would be out of the question.
concerns of the countries
If you want, you can hear the message: The whole thing won’t be that easy. The federal states will not wave the plans of the Federal Minister of Health through without objection.
The hospital reform is one of Karl Lauterbach’s prestige projects. Weeks ago he presented to the press and the general public what it should look like – including the federal states or not. The previous system of flat rates per case should be largely passé, instead the provision of services should be better remunerated. This should take the economic pressure off the hospitals and massively reduce the number of unnecessary interventions that are carried out primarily for economic reasons. In addition, the hospitals are to be divided into different service categories. Small hospitals should concentrate on basic care, more complex interventions should be carried out primarily in large clinics with the appropriate specialization.
The plans are based on the proposals of an expert commission that has been working on the concept since last May – and they made some country representatives nervous even before the consultations began. Brandenburg’s Health Minister Ursula Nonnemacher (Greens) expressed concern that clinics could be closed on a large scale. She fears that the reform should actually “lead to centralization and the dismantling of hospitals in Germany,” said Nonnemacher. Small houses in particular are at risk – and with it “ensuring nationwide supply”.
One of the toughest critics is missing
Karl Lauterbach says that such worries are based on a misunderstanding, that the reform will rather ensure that the clinics are rescued from their sometimes existence-threatening economic bottlenecks. Currently, 60 percent of the 1,900 hospitals in Germany are facing massive financial problems. There are also major problems with staff and treatment quality. That has to change. In this first meeting, a precise working method was agreed, and the draft law for the reform, which was put together by the federal and state governments, should be ready by the summer.
Behrens calls this project a “mammoth task” – perhaps meaning not only the complexity of the matter, but also the different interests involved. “No federal template should be placed over the hospitals,” says North Rhine-Westphalia Minister Laumann. The hospital landscape in the different regions of Germany is far too diverse for that. But a “federal template” is exactly what Lauterbach has declared to be the core of his reform plans: categories for the hospitals that regulate exactly who offers what services and what quality – and which not.
In addition, one of Lauterbach’s toughest critics was not present at this first meeting – the Bavarian Health Minister Klaus Holetschek (CSU) was at the funeral of Pope Benedict XVI. in Rome and therefore missed the start of the consultations on hospital reform. Afterwards, however, he let it be known that one thing was needed above all: a lot more money. “Without additional funds for the clinics, Lauterbach’s hospital reform is doomed to fail,” said Holetschek.