faq
Health Minister Lauterbach has agreed with the federal states on key points for hospital reform. What should the new financing for clinics look like and what are the next steps? An overview.
the initial situation
In the struggle to reorganize the hospitals in Germany, a basic understanding has been reached with the federal states. The key issues paper that Federal Minister of Health Karl Lauterbach and the health ministers of the federal states have now agreed on is also available tagesschau.de before.
The federal and state governments had previously negotiated the reform for months. After a meeting in early July, the fronts seemed hardened. A central point of contention was the money: the federal states wanted money from the federal government to finance the conversion of the hospital landscape. In addition, they called for further emergency aid to save ailing hospitals from bankruptcy in the short term.
What’s with the hospital reform planned?
The core of the plans is to change the remuneration system with lump sums for treatment cases. This should free hospitals from economic pressure and a “hamster wheel”, as Lauterbach explained – i.e. from the financial pressure of having to take on more and more cases and sometimes also carrying out interventions for which there is no great expertise.
Instead, the clinics should receive a large proportion of the remuneration for the provision of staff, technology, emergency rooms and other services. Instead of the previously customary DRG (Diagnosis Related Groups) case flat rates, there should be provision budgets in the future.
How exactly are the budgets calculated?
The basis of the financing by the health insurance companies should be more precisely defined performance groups of the clinics – for example “cardiology” instead of rough terms like “internal medicine”. The performance groups are intended to ensure uniform quality specifications, for example in terms of equipment, staff and treatment experience.
The federal and state governments want to work out together which quality criteria should apply to the performance groups. According to the key issues paper, the initial definition should be based on the service groups introduced in North Rhine-Westphalia – plus five additional, technically required service groups: infectiology, emergency medicine, special traumatology, special pediatric and adolescent medicine and special pediatric and adolescent surgery.
However, because it is still a long time before service groups and quality criteria are defined, the retention shares should initially be set at 60 percent of the DRG remuneration in the transition phase. This should also include the costs for nursing staff at the bedside.
How should patients be informed?
Federal Minister of Health Lauterbach is also planning a “Transparency Act” with which data on the quality of treatment in all clinics will be published as information for patients. To this end, the federal government wants to make the distribution of service groups among the houses and a division into levels of care, so-called levels, transparent.
There was no agreement in the federal-state group about a stronger controlling function of the levels. What is meant is classification of the clinic network in stages – from basic care close to home to standard and specialized care to maximum care, for example in university clinics.
Is there already money for the clinics?
Demands from the federal states for a financial injection from the federal government for the clinics before the reform were not implemented. Lauterbach also said with a view to the budget situation that it would be checked, but added: “I can’t hope for that.” Unfortunately, clinics would still go bankrupt before the reform took effect. But that’s because the reform wasn’t made earlier.
What’s next?
According to Lauterbach, 14 of the 16 federal states voted for the key points today. Bavaria voted against, Schleswig-Holstein abstained.
A joint federal-state group will work out a concrete draft law over the summer. The financing should also be clarified. According to Lauterbach, Hamburg, Baden-Württemberg, Mecklenburg-Western Pomerania and North Rhine-Westphalia will also work on the draft.
The law is scheduled to come into force on January 1st. Concrete implementation in the local clinics should then start step by step.
How do other politicians react to the agreement?
Health politicians in the traffic light coalition have welcomed the agreement between the federal and state governments on the cornerstones of a hospital reform. After tough, but also constructive negotiations, there is a “good result,” said the deputy SPD parliamentary group leader Dagmar Schmidt. The quality of hospital treatment will be significantly improved and nationwide care will be ensured.
Armin Grau, health expert for the Greens, explained that the agreement had “achieved an important milestone in hospital reform”. There is “a common basic understanding of the reform goals” for the drafting of the law that is now necessary. The timetable to put this into effect as early as January 1, 2024 is “very ambitious”.
The FDP health politician Lars Lindemann also supported the plans to publish quality data for hospitals. “We need a great deal of openness about what certain structures in the hospital sector are capable of doing,” he told the “Ärzte Zeitung”. Hospitals that cannot provide certain services at a certain level of quality would have to stop doing so and withdraw. “It’s painful, but that’s the way it is.”