Hospital reform: fewer clinics, but more quality?


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Status: 07/10/2023 06:11 a.m

Hospital reform is slow to get off the ground. Health Minister Lauterbach wants to negotiate with the federal states today. But there are still many controversial points, as a paper by the federal states shows.

Actually, Karl Lauterbach shouldn’t be in the mood to laugh so much anymore – at least as far as his much-announced hospital reform is concerned. Negotiations with the federal states are progressing slowly. Progress has already been announced several times, only to be explained afterwards that there was disagreement on essential points. But the Federal Minister of Health has not lost his sense of humor. The minister likes to let his followers know that on Twitter: There he reported on Friday about the visit of two comedians in his house.

But today threatens to be a long day, which could significantly worsen the minister’s mood. Lauterbach sees his reform at a crossroads. Actually, the plan for the future of hospitals should have been ready long ago. So far, however, the federal and state governments have not been able to agree on common key points.

Today, Lauterbach wants to sit with everyone in the ministry for as long as it takes to find compromises. “But we can’t make any lazy compromises here,” emphasizes the minister. He has sounded more optimistic that an agreement will be reached.

It’s also about the money

The federal and state governments have been negotiating the reform for months. After a meeting in early July, the fronts seemed hardened. When it comes to key issues, they continue to cross paths. A central point of contention: the money. The states want money from the federal government to finance the restructuring of the clinic landscape. In addition, they are calling for further emergency aid to save ailing hospitals from bankruptcy in the short term. The countries refer to the increased energy costs and tariff increases, which are already putting a heavy strain on many clinics.

“This is a topic where we are very, very far apart,” says the Bavarian Minister of Health, CSU politician Klaus Holetschek. Because Lauterbach rejects further emergency aid. He no longer wants to distribute the money with the watering can, but only invest in the reform and thus in the conversion of the hospital landscape. Especially since further aid money for the clinics does not match the austerity measures of the traffic light.

performance groups based on the example of North Rhine-Westphalia

Instead, Lauterbach wants to concentrate supply in order to improve quality. This means that not all hospitals should offer all treatments. He relies on studies that show that the probability of survival for some diseases increases significantly if you are treated in specialized hospitals. Smaller houses should only be able to carry out and bill for treatments for which they are qualified.

The plan provides for the states to allocate so-called performance groups to the hospitals based on the model in North Rhine-Westphalia, for example cardiology or a stroke center. It is intended to define nationwide minimum requirements for medical equipment and staff. The service groups show which operations can be carried out or which illnesses can be treated in the houses. Only if a certain quality is guaranteed should the clinics receive money for it.

But here, too, details are still being debated. The federal states want to ensure that the federal government does not use these service groups to intervene in their planning sovereignty through the back door. Lauterbach and also the members of the Bundestag would have to recognize the competences of the federal states, said the Bavarian Health Minister Holetschek again before the round of negotiations.

Health insurance companies are pushing for an agreement

The minister does not like to focus on the fact that all of this will also result in the closure of clinics. Lauterbach never tires of emphasizing that his main concern is that patients are well cared for. That’s why he wants to publish the quality of the clinics in an interactive map. With information such as the number of procedures performed, specialist doctors and any complications that have occurred. The federal states are resisting this – they fear that smaller clinics in particular could lose patients and staff as a result.

The health insurance companies are pushing for an agreement. The insurers like the fact that Lauterbach wants to publish clear information about the quality of the clinics. In addition to cutting-edge medicine in certified centers, there are currently also clinics that perform procedures without the necessary technical equipment and experience, says Carola Reimann, chairwoman of the AOK federal association. That is unacceptable.

For the patients, however, these differences are usually not transparent. Therefore, in the future, it should be clearly recognizable which hospital has been assigned which service groups, says Reimann. In this way, people could be sure that the appropriate quality standards are being met.

Less economic pressure

The federal and state governments are largely in agreement that there should be less economic pressure in the clinics. Therefore, the financing system should change fundamentally. So far, the clinics have been paid for each case treated, so they get money for operations and examinations that have been carried out. In the future there should be more money for fixed costs, for example for ensuring that there are enough staff or that the wards and emergency rooms are technically well equipped.

From a paper by the countries that dem ARD Capital Studio is available, but there are numerous disputed points with the federal government. Among other things, it is still unclear how these fixed costs of the clinics are to be calculated in concrete terms. So far, there has also been no sign of a compromise as to whether hospitals receive less money or no money at all if they do not meet quality criteria.

Lauterbach wants houses that do not meet certain quality standards not to receive any money for these interventions. The countries take a critical view of this and still need to talk. There is also disagreement about when the countries will have to implement the reform.

Traffic light agrees

No matter how much headwind Lauterbach gets from the federal states – the traffic light coalition is more united in the planned hospital reform than in almost any other topic. If you talk to health politicians from the FDP and the Greens these days, anger can now be heard in their voices. There is talk of a blockade attitude among the countries. It must now finally move forward.

For the health policy spokesman for the Greens, Janosch Dahmen, it is clear that many hospitals have no chance of survival without reform. That is why the law must continue to be worked on in the summer without a break – with the aim of “saving the right clinics and ensuring good care at the right time in the right place,” says Dahmen.

Is there a risk of death in the clinic?

Experts largely agree that hospital reform is necessary – also in order to pool staff more efficiently at fewer hospital locations in the future. There are fewer nurses and doctors, but at the same time there are more and more older people. Without reform, the system could reach its limits, says intensive care physician Christian Karagiannidis. He advises the government as a member of the hospital commission. His biggest concern is the “total watering down of the reform” with too many exemptions.

Karagiannidis speaks of a “golden moment”: Now there is still a chance to structure the hospital landscape in such a way that patients are well cared for. Otherwise there would be a risk of benefit cuts, especially because the shortage of staff due to demographic change could no longer be stopped.

It is already clear that not all clinics will survive the next few years – with or without reform. The German Hospital Society assumes that in the next ten years about every fifth clinic will have to be merged with others, redesigned or closed.

So the question is: will a reform be successful that will specifically restructure the hospital landscape, or will there be an uncontrolled death of hospitals? Minister of Health Lauterbach has many arguments on his side to initiate a reform. Now he just has to convince the countries. In view of the many points of contention, it should not be a very amusing federal-state meeting in the Ministry of Health.

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