When it came to hospital development recently, the Ministry of Health had reports of success in which the headings began with the same word: “Holetschek is pushing ahead with the expansion of inpatient care in rural areas.” It was about extensions – sometimes in Freyung, sometimes in Burgau and Günzburg. But the number of those who warn against a concentration of clinic locations at the expense of rural areas is not decreasing. The Bavarian District Association recently called for an end to the “thinning of the hospital structures through an increasing shortage of revenues” in the direction of Berlin.
The left parliamentary group now has the answers to its request regarding the “quality of work and life in Bavaria”. The developments mentioned therein confirm the fears of those who are fighting for the continued existence of their small hospitals and maternity wards at the local level. “The whole system is sick and urgently needs treatment,” says Susanne Ferschl, left-wing MP from the Ostallgäu constituency. From the figures that she has for the period from 1993 to 2019, she reads a sharp reduction due to bed downsizing and closings – especially in gynecology, obstetrics and paediatrics. “The number of beds in the specialist obstetrics / gynecology departments fell by 55 percent between 1993 and 2019 – by 43 percent since 2003,” says Ferschl. The bottom line: “The number of beds available in these specialist departments has halved since 1993.”
Angelika Pflaum, who has fought in vain with others for years to keep the hospital in Hersbruck in Central Franconia, blames the flat rate system for this development. According to the health system researcher Michael Simon, clinics generate “currently 70 to 90 percent” of their budget via this system, with which medical services are remunerated in the form of fixed amounts. From Pflaum’s point of view, this reinforces developments that no one can support: “A normal delivery brings a hospital less money than it has to invest for this service.” Children, she read in a specialist magazine, would become “part of an economic cycle that is not based on need but on income” even before they were born.
“Operational thinking in the health sector endangers the health of patients and employees”, stressed Ferschl meanwhile. While the closure of clinics will be a problem for people in rural areas in particular, “the intensification of work and outsourcing are making the employees sick,” she says. Many clinics have outsourced entire areas of activity in order to reduce expenses – at the expense of the quality of work of cleaning staff, craftsmen or kitchen staff.
The Left MP is not alone with this assessment. The Bavarian Social Network, which includes not only the trade unions but also charities, comes to the conclusion “that the public care and health system has been cut to pieces in crucial places over the past 30 years”. How much this applies to the care sector becomes apparent in times of the pandemic.
“We need new financing,” says Thomas Egginger, CEO of the North Upper Palatinate Clinics, with certainty – just one voice among many in the Bavarian hospital industry. This is followed by the district day. Refinancing of the holding costs must again be possible through the remuneration to be achieved.
When asked on Tuesday, Health Minister Holetschek said that he also considered the “current system no longer up-to-date”. Bavaria therefore vehemently demand a fundamental review of the flat rate system. “We urgently need a reform,” said Holetschek. The aim is to ensure basic acute inpatient care also in rural areas.