The federal government’s monopolies commission is opposed to Health Minister Lauterbach’s plans for hospital reform. She fears that basic medical care will be sold out and instead wants to help rural clinics more.
It is one of the most difficult projects of the traffic light coalition. Hundreds of thousands of employees tremble for their jobs, millions of Germans for their medical treatment. The reform of the clinics affects everyone. Will rural hospitals soon die? Do doctors and nurses have to work harder and harder? Does profit matter more than health?
A panel of experts from Health Minister Karl Lauterbach (SPD) recently presented ideas on how the clinics should be fit for the future. They want to focus treatment in large facilities and turn smaller homes into outpatient care centers with attached medical specialists. Critics fear a clear cut, hundreds of clinics, especially in rural areas, could be closed forever. Now the Monopolies Commission, also a government body, is helping the small clinics. In a statement, they call for “hospitals to be available, even if they can be operated less efficiently because of their general conditions”. The consultants want to redirect the flow of money in the healthcare system, so funds from densely populated regions like Berlin could flow into sparsely populated areas like the Uckermark in Brandenburg.
Lauterbach wants the end of the health factories
In the past decade, Germany’s hospitals have become health factories in which doctors operate on assembly lines. The culprits are the “flat rates per case”, fixed sums of money that are due for an operation. For a heart catheter examination, 6,000 euros flows, for a new hip joint 7,500 euros. The clinic managers therefore encourage the doctors to resort to the scalpel as often as possible, they are reluctant to give lucrative cases to other clinics, even though they could sometimes be treated better there. Surgeons in large clinics often have more experience because they operate more frequently.
Corona, war and inflation have exacerbated the situation in the clinics. Expenditure on electricity, medical devices and food has risen, and income has fallen because fewer people had surgery during the pandemic (in 2021 it was 14 percent fewer than before the epidemic). Three out of five clinics are now in the red. Doctors and nurses feel more and more overburdened, drop out or quit, so that the hospitals close more wards. “The risk of bankruptcy is increasing for many clinics,” medical associations recently complained in a letter to Lauterbach.
Its clinic experts now want to paralyze the system of the health factory. The hospitals should get less money for operations, but more for providing beds, equipment, doctors and nurses. The fire brigade principle is a role model. Firefighters are also not paid for the number of times they put out a fire, but for being there and rushing to the scene of the fire in an emergency.
Case flat rates are to be reduced by 60 percent
Specifically, Lauterbach’s experts are calling for the case flat rates to be reduced by up to 60 percent and so-called “reserve flat rates” to be introduced. The houses should be financed more stable. The Monopolies Commission doubts that. They fear that the more patients a clinic operates on, the more money it would receive in the new system. “The distribution of the funds will differ only slightly from the financing through case flat rates,” says the statement.
In rural areas, where the clinics often take care of fewer patients and the hospitals are often in the red, the planned reform could make the situation worse. Because the “securing of the necessary needs in regions with a low number of cases is not achieved or only with difficulty,” says the statement. But this is necessary. In some areas there are emergency stations that only take care of two cases per night and can hardly be operated profitably, according to the commission. Nevertheless, these areas also need an emergency station.
As a way out, the Monopolies Commission proposes revising the planned reform. Lauterbach’s clinic experts should also consider how many people live in the vicinity of a clinic, how difficult it is to keep operations running there, and how expensive some areas have become. A so-called “regional equalization” between densely and sparsely populated areas could help.
What will become of the ideas is unclear
What will become of the Monopolies Commission’s ideas is unclear. The federal and state governments want to present a clinical reform by the summer. The basis should be the plans of Lauterbach’s expert panel. Many countries reject their proposals. The Bavarian Prime Minister Markus Söder (CSU) said that Bavaria would “fight tooth and nail against this reform”. Above all, the federal states are demanding additional billions for the project, but Lauterbach is reluctant to do so. He wants to finance the reform by redistributing the existing funds. Every year, 100 billion euros flow into hospitals in this country, there are six hospital beds per 1000 inhabitants, only Japan and South Korea have more.
Source: Stern
I have been working in the news industry for over 6 years, first as a reporter and now as an editor. I have covered politics extensively, and my work has appeared in major newspapers and online news outlets around the world. In addition to my writing, I also contribute regularly to 24 Hours World.
