Health: The federal and state governments find a line for hospital reform

After weeks of dispute, the federal and state governments have agreed on the basics for a reorganization of the clinics in Germany. It was possible to agree on very detailed key points, said Federal Health Minister Karl Lauterbach (SPD) after joint consultations.

The reform is “a kind of revolution”. Hospitals are no longer forced to provide as many services as possible. Better quality for patients should be guaranteed and made transparent. 14 of the 16 countries agreed to the concept. A bill is expected to be drafted over the summer. The reform is scheduled to come into force at the beginning of 2024.

The chairman of the state health ministers, Manne Lucha (Greens) from Baden-Württemberg, emphasized the principle of “the right offer in the right place” – this also avoids “born loss-makers” among the clinics. Hamburg Senator Melanie Schlotzhauer (SPD) said the common goal was for operations “in Bottrop, Buxtehude and in Hamburg-Barmbek” to have consistent quality. The reform will lead to taking stress out of the system. The North Rhine-Westphalian department head Karl-Josef Laumann (CDU) said he was “rejoiced” that the window of opportunity for the reform would be used.

Two countries did not agree to the key points – Bavaria voted no, Schleswig-Holstein abstained. An overview of the key points:

compensation

The reform plans envisage changing the long-controversial remuneration system with lump sums for treatment cases. This should free hospitals from economic pressure and a “hamster wheel”, as Lauterbach explained – i.e. from pressure on more and more cases and sometimes also interventions for which there is not much expertise. In the future, therefore, there should be a large proportion of the remuneration simply for the provision of service offers themselves.

task sharing

In the future, the basis of financing by the health insurance companies should be more precisely defined service groups – for example “cardiology” instead of rough terms like “internal medicine”. For this, uniform quality specifications must be met, for example in terms of equipment, staff and treatment experience. This leads to a concentration of more complex treatments, such as cancer, in specialized hospitals. Lauterbach explained that the small clinics could concentrate on what they are particularly good at, namely taking care of simple cases.

transparency

Lauterbach is also planning a “transparency law” and wants to publish data on the treatment quality of all clinics as information for patients. The federal government intends to implement this by January 1, 2024. The distribution of the service groups in the clinics and a division of the network into “levels” should be made transparent – from basic care close to home to a second level with other offers up to maximum care providers such as university clinics. The federal states had previously rejected a more direct role for these levels in the reform.

Time schedule

The state side of Hamburg, Baden-Württemberg, North Rhine-Westphalia and Mecklenburg-Western Pomerania in eastern Germany are to be involved in drafting the law. Lauterbach said the schedule is set for the reform to come into effect on January 1, 2024. The concrete implementation in the budgets of the clinics should only gradually take effect in the years that follow.

finance

There was recently a tussle over demands from the federal states for an upstream extra financial injection from the federal government in view of the acute financial needs of many clinics. Lauterbach also said with a view to the budget situation that this would be checked, but immediately added: “I can’t hope for that.” Unfortunately, clinics would still go bankrupt before the reform took effect – but that was because the reform had not been made earlier.

The Bavarian Health Minister Klaus Holetschek (CSU) criticized the key points as insufficient. Bayern’s dissenting vote is “not an attitude of refusal”. The German Hospital Society complained about the lack of planning security and warned: “The wave of insolvencies is rolling and the care will deteriorate.” The head of Techniker Krankenkasse, Jens Baas, spoke of a “big step towards more quality in hospital care”.

Representatives of the coalition factions in the federal government also took part in the deliberations. Green expert Janosch Dahmen said: “The reform will save clinics and ensure the right care at the right time in the right place. Competition will turn into cooperation between the clinics.” Christine Aschenberg-Dugnus (FDP) said: “In the future, quality will be the motto instead of quantity.” The German Foundation for Patient Protection called for different age groups to be given special consideration when assessing the quality of treatment – including those over 75, who should not be left behind as the elderly and risk patients.