According to the plans of Health Minister Karl Lauterbach, the clinics in Germany are to be fundamentally freed from economic pressure at the expense of patients and staff. "Medicine is once again being placed in the foreground of therapy and not following the economy," said the SPD politician on Tuesday at the presentation of proposals for a comprehensive financial reform. The concept of a government commission, which is to become the basis for legislative plans, envisages changes to the controversial reimbursement system with flat rates for treatment cases and reorganization of the clinics.
Lauterbach said in Berlin that the reform plans were about "a revolution in the hospital sector," which was absolutely necessary. "We have pushed the economy too far," he stated. "At the moment, mediocrity and quantity are rewarded too often." Instead, good basic care must be guaranteed for everyone - and special interventions must be concentrated in particularly well-equipped clinics.
situation dramatically worsened
The situation: The chairman of the government commission, Tom Bschor, said the crisis with closed departments and patient transfers to distant hospitals had escalated dramatically. It burns brightly. Personnel and money in the clinics would be consumed by the logic of the remuneration system and disproportionate profit expectations by operators. "We have mass instead of quality." There is a risk that "hospital care will collapse with catastrophic consequences if we do not reform fundamentally now".
The flat rates: The remuneration via case flat rates was introduced almost 20 years ago to make the system more efficient - Lauterbach was also involved as a consultant at the time. According to a catalog with case and diagnosis groups, clinics receive a lump sum from the health insurance company for each treatment case. The logic: the more cases and the cheaper the treatment, the higher the profit. This is how the clinics “get into a hamster wheel”, as Lauterbach said. Costs for the nursing staff have already been removed from the lump sums in order to eliminate the pressure to save. The cash registers pay all costs incurred.
New fixed-cost reimbursement: Hospitals have previously also had to finance the fixed costs of the basic equipment largely through the lump sums. This includes personnel or medical technology that is kept available for specific cases, even if it is not used constantly. According to the concept, clinics should receive a share of 40 to 60 percent of the remuneration as a secure base - regardless of the number of cases. It's like the fire brigade, which is also financed for "being there".
Targeted financing planned
New levels: It is proposed to classify the grown network of clinics into three "care levels" with uniform minimum requirements and to finance them in a targeted manner. "Basic care" houses close to home should be there for emergencies or basic surgical interventions and should go completely outside of the case-based flat-rate system. There should also be combined offers from clinic and practice doctors. Level two should include clinics with more extensive services, level three the maximum care of the university clinics.
New service groups: The clinic remuneration should also be based on more precisely defined specialist areas. Instead of rough descriptions such as "internal medicine", clinics should be assigned to more precisely defined groups such as "cardiology" and remunerated accordingly. This should also mean that, for example, cancer treatments are carried out in certified clinics with special knowledge. People could rest easy knowing that hospitals that are really needed can survive in rural areas and underserved neighborhoods without having to deal with increasing numbers of cases, Lauterbach said.
The finances: The bottom line is that the reform should not cause any additional costs, explained Commission Chairman Bschor. Treatments that are not medically necessary should be eliminated due to financial incentives. The expenses for the approximately 1,900 clinics are already the largest single item in statutory health insurance. According to the National Association of Statutory Health Insurance Funds, almost 85.9 billion euros were incurred last year - about every third euro of the total service expenditure of 263 billion euros.
The roadmap: The Commission proposes not to implement the major operation immediately - but gradually and with a transition phase of five years. The traffic light coalition groups welcomed the concept as a "good basis" and also want to talk to the federal states, which should remain responsible for hospital planning. Criticism came from the opposition. Union health expert Tino Sorge (CDU) spoke of “another incomplete concept”. There are no industry representatives on the commission. Lauterbach made it clear that lobby groups with technical information should be heard. However, they should "have no influence on the political implementation".
