Health: Clinic reform: Lauterbach and its six problems

Time is pressing, many clinics are on the verge of collapse – but the federal and state health ministers were unable to resolve their differences on clinic reform at a two-day conference on Lake Constance.

Federal Minister of Health Karl Lauterbach spoke of no fewer than “six remaining major problems” that Friedrichshafen could not resolve. The SPD politician mentioned, for example, the federal government’s demand for more transparency for patients with regard to the quality of the clinics – and against which the federal states blocked themselves.

Differences in the design of the performance groups

Even with the design of the so-called performance groups, there are still miles apart. Instead of rough descriptions such as “internal medicine”, they aim to assign patients to more precisely defined groups and pay them accordingly – and thus also ensure the quality of care at the clinics. The federal states believed that the federal government wanted to take control of hospital planning by designing the service groups, said the federal minister.

“Distrust” was mentioned several times at the press conference. “We have to develop trust in each other’s positions, otherwise the reform will fail,” said Bavarian Health Minister Klaus Holetschek (CSU).

Time of reform and impending hospital deaths

The law is scheduled to come into force on January 1, 2024. On Monday there is another meeting between the health ministers and the parliamentary groups in Berlin. Lauterbach said he remains confident that a result will be achieved there – but that is not certain. The Federal Minister warned that one is now at a crossroads as to whether one wants the reform at all or not. Only with her can a systematic death in hospitals in Germany be averted.

The chairman of the health ministers’ conference, Baden-Württemberg’s health minister Manne Lucha, said before the conference that an agreement had to be reached in Friedrichshafen. The Greens politician then said that the points that still had to be clarified with the parliamentary groups had now been identified more clearly. Lucha cited the so-called advance financing as an example: the federal states are insisting on bridging financing from the federal government so that economically ailing hospitals do not go bankrupt before the reform takes effect. “Systemically important clinics must not kneel before the reform,” said conference host Lucha.

Melanie Schlotzhauer, SPD health senator from Hamburg and spokeswoman for the SPD-led countries, made it clear that an agreement on Lake Constance before the meeting with the parliamentary groups would have been impossible from the outset – “because important partners are not at the table”.

Concerns about reputation damage and clinic ruin

There is also disagreement between the federal and state governments as to which data on the quality of the clinics should be made available to patients and how quickly. Lauterbach wants to publish this data as soon as possible – even before the reform takes effect. He spoke of two different ideas of speeds from the federal and state governments.

It is not acceptable for the federal government to wait until the reform takes effect with transparency, said the SPD politician – and named the year 2027. “In these three years, 1.5 million Germans will get cancer,” he said. They would have to know how often cancer is treated in a clinic, whether there are specialists in oncology, how many nursing staff are available and what the complication rate is.

Lauterbach admitted that some clinics that were already in financial difficulties would lose “one or the other cancer patient” as a result. However, it is ethically “not at all acceptable” that cancer patients are still being treated just so that a clinic can survive in the transition phase. The data should be made available to citizens as soon as possible.

The countries fear that this could damage the reputation of some clinics and ruin them economically. The Hamburg department head Schlotzhauer said that the data should not be published before the reform is implemented and would have to be validated by the federal states. There are also information portals.

The Bavarian Health Minister Holetschek was disappointed that there were still so many different points. Optimal supply structures are also needed for people in rural areas, they should not be left alone. He also believes that there will still be major distortions between the groups and the countries.