Status: 06.12.2022 06:24
Clinics receive a specific fee for each patient and diagnosis, regardless of the services provided. This system of flat rates per case puts clinics under great economic pressure. How can a reform look like?
A child breaks his arm in school sports, an older patient needs medical treatment because of acute shortness of breath. It is emergencies like this that bring people to the Wegscheid hospital. The clinic is located in a rural region in Lower Bavaria near the Austrian border. An important contact point that you do not want to miss here. About 2,800 emergencies are treated in the clinic every year, says managing director Josef Mader. There are about 3000 inpatients. But the hospital has been in the red for years. The district is willing to support the clinic financially. In the long run, however, things cannot go on like this, says Mader. Also because new requirements would exacerbate the tense financial situation in the coming year.
The residents already fear the end of the general hospital with inpatient emergency care. They have been mobilizing to maintain the clinic for a long time. “SOS – We need the Wegscheid hospital,” read their posters when they marched in front of the district office in Passau for a rally in November.
Plans for hospital reform
Federal Minister of Health Lauterbach will present the plans for a reform of hospital care in the morning. The reform proposals were drawn up by a government commission set up in May. The goal is the end of the financing system via so-called flat rates per case. In contrast to outpatient medical treatment, the level of hospital reimbursement does not depend on the individual services rendered. It depends on the diagnoses being treated. There is a catalog of diagnosis-related case flat rates for this. Lauterbach sees more disadvantages than advantages in this. Areas in which no profit can be made would be disadvantaged.
Dr. Understand Willibald Prügl. You have the right to adequate and quick treatment in an emergency, says the medical director of the hospital. There are only two ambulances in the area. If both of them could no longer drive to the Wegscheid hospital and instead had to drive to the hospital in Passau, this could lead to bottlenecks in care, the doctor fears.
There have been flat rates per case since 2004
It is such examples that make the deficits of the current billing system for hospitals clear. Since 2004, the clinics have been billing on the basis of so-called diagnosis-related case flat rates. The aim of politics was to increase the profitability of hospitals. But small rural clinics that provide primary and emergency care are struggling to treat enough cases to be economically viable. Larger houses in urban areas also struggle with the system.
The economic pressure is high. Wherever you ask around in the industry, there is dissatisfaction. Gerald Gass from the German Hospital Society calls for a reform of the case-based flat rate system. “Because the provision costs are insufficiently represented.” This was shown very clearly not least in the pandemic. Without adequate funding, nationwide coverage is not possible, especially in times of crisis. The pure power consumption of the system reaches its limits here, says Gass.
take maintenance costs into account
Politicians have long recognized this, but have not dared to tackle the problem for years. With the proposals of the government commission, that could now change. Professor Christian Karagiannidis, a member of the Government Commission, advocates taking the upfront costs into account more extensively when financing hospitals. In other words, the costs that arise from the provision of personnel and medical equipment, for example. “I would see this lump sum as similar to that of the fire brigade, for example,” says intensive care physician Karagiannidis. Simply being there for the population around the clock – such a higher flat rate is enormously important in order to reduce the economic pressure in the clinics.
Higher basic budget?
However, the experts probably do not have a complete abolition of the case-based flat rates in mind. The performance pillar should be weakened, says Professor Boris Augurzky, also a member of the government commission. For example, for a hospital that cares for children, this would mean: The basic budget for pediatrics would be increased, regardless of how many treatments are performed. The financing via case flat rates would be retained. However, the economic pressure would be reduced. Smaller hospitals in rural areas could also benefit, says Augurzky. If they have a supply contract, the reserve budget should be increased.
The “biggest reform in 20 years”?
Health Minister Karl Lauterbach, who once helped introduce the case-based flat rate, promises the “biggest reform in 20 years”, “overcoming the case-based flat rate system” and the “end of economization in the clinics”.
The experts’ suggestions probably don’t go that far. And the risk that Lauterbach’s far-reaching announcements will disappoint expectations is great.
In Wegscheid, they have long since started looking for solutions themselves. The structures of the hospital are to be revised. There is talk of expanding outpatient care, for example by offering an outpatient surgery centre. In this way they hope to be able to ensure the continued existence of the clinic and emergency care on site in the long term. However, they expect support from politicians in Berlin so that medical care can also be guaranteed outside of the cities.