Federal Health Minister Karl Lauterbach has presented plans for a fundamental reform of hospital care. The declared goal is to ease the financial pressure on them. For this purpose, the previous remuneration for flat rates for treatment cases is to be decisively changed. The reform proposals were drawn up by a commission of experts set up by the federal government in May.
“The hospitals have serious problems,” said Lauterbach. The main problem is the case flat rates that have been in force up to now. This system favors the trend towards “cheap medicine” and drives hospitals to treat as many cases as possible, as this is the only way they can increase their income. It is unique in this form in Europe. Lauterbach spoke of nothing less than a “revolution” in restructuring hospital financing, which is now being initiated.
According to Lauterbach, from the patient’s point of view it is important that the change ensures that rural hospitals in particular, which are important for the area supply, are secured in their existence: They no longer have to try to treat more and more cases in order to be able to survive. In addition, work in the health sector should become more attractive. This is important in order to be able to provide good care to patients.
Tom Bschor, coordinator of the Government Commission on Hospital Supply, explained the planned steps. In the future, equipment and personnel are to be paid to a greater extent independently of case flat rates, which will become less important as a result. In addition, hospitals are to be divided into three classes: The local, regional or national levels are intended to enable uniform planning throughout Germany according to the needs of the population. The requirements that the respective hospitals have to meet are also to be defined more precisely and precisely. The aim is to form centers of expertise. If you have a certain disease, you should go to a hospital that specializes in it.
In the German healthcare system, there is “mass instead of class,” said Bschor. Although case flat rates are also the basis of other health systems, their importance in financing clinics is too high in Germany. The reform was worked out in an “extremely intensive scientific work process”, said Bschor.
When asked if he could say how many unnecessary surgeries are being done because of the flat-rate system, Lauterbach said it hasn’t been adequately researched scientifically. There is, however, the realization that so far very sick people are often still operated on at the end of their lives, although the interventions probably no longer bring any great medical benefit.
The remuneration via case flat rates was introduced almost 20 years ago in order to make the system more efficient and, for example, to shorten the hospital stays for patients. There is a catalog with case and diagnosis groups for this. The clinics then receive a flat-rate amount in euros from the respective health insurance company for each patient or case of treatment, as the Central Association of Statutory Health Insurance Funds (GKV) explains. The more patients a clinic treats, the more revenue it generates. Costs for nursing staff have already been removed from the flat rates in order to eliminate the pressure to save on nursing. The cash registers pay all costs incurred.
Overall, the expenses for the nationwide around 1900 clinics make up the largest individual item in the statutory health insurance (GKV). According to the National Association of Statutory Health Insurance Funds, almost 85.9 billion euros were incurred last year – and thus around one in three euros in relation to the total benefit expenditure of 263 billion euros. In general, the financing of the hospitals is divided into two parts: the operating costs including staff are paid by the health insurance companies, investment costs such as for new buildings or new equipment are to be financed by the federal states.
The Bundestag recently passed a first package of laws that, among other things, provides more money for children’s hospitals, which are currently at the load limit. However, the German Hospital Society called for an overall concept for a reform. “The constant detachment of individual solutions brings more distortions than progress in the system,” said CEO Gerald Gass, the newspapers of the Funke media group. First of all, the financing gap in the operating and investment costs of the clinics must be closed before the funds can be redistributed.