After years of tugging, the federal government wants to tackle a major reform of the future of the clinics. Economic pressure is supposed to come out in order to ensure a good supply. It won’t be easy.
In the struggle for a fundamental realignment of hospitals in Germany, the financial role of the federal states is also being targeted.
Federal Minister of Health Karl Lauterbach (SPD) told the “Handelsblatt” with regard to a planned reform: “Initially, the federal states not only have the right to plan the hospitals, they also have the obligation to invest in the hospitals.” Clinics and health insurance companies have been demanding more money for this for years. A federal-state working group is to continue to discuss reform recommendations from a government commission.
Lauterbach expressed his confidence that joint solutions could be found. “We will agree to close the investment deficit. Otherwise the hospitals will continue to have a financial problem.” All in all, the expenses for the approximately 1900 clinics make up the largest individual item in the statutory health insurance funds. According to the association, it was more than 80 billion euros in 2021 and thus about every third euro measured in terms of all service expenditure. In general, the financing of the hospitals is divided into two parts: the operating costs, including staff, are paid by the health insurers, investment costs such as for new buildings or new equipment are to be financed by the federal states.
The German Hospital Society recently complained that the federal states had not complied with this obligation in 2021 either. An investment requirement of 6.7 billion euros would have faced 3.3 billion euros in payments. The problem of “massive underfunding” that has been known for three decades is continuing.
In the planned reform of financing and reorganization of the clinics, several countries expressly insist on responsibility for hospital planning. Lauterbach defended the project and recently turned against some “panic-mongering indications” that this would lead to a reduction in hospitals. “Without the reform, there will be uncontrolled hospital deaths across the board,” he said recently. The aim is to improve quality, reduce oversupply and de-economize the entire system.
The concept of a government commission, which is to form the basis of the law, provides for changes to the reimbursement system via lump sums for treatment cases. In order not to be dependent on more and more cases, clinics should in future be rewarded with a share for the provision of services. The focus is also on classifying the historically grown network of clinics into three care levels and financing them accordingly – from basic care close to home to maximum care providers such as university clinics.
Lauterbach wants to discuss the legislative plans, which the Federal Council must approve, in depth with the federal states. Thursday’s deliberation was to be the second of six agreed meetings.
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