Health care: hospital reform on the home stretch

Hospitals in Germany should be relieved of financial pressure and specialize more. This is the aim of a reform by Federal Health Minister Karl Lauterbach (SPD), which the Bundestag is expected to pass today. The traffic light coalition’s legal plans are intended to change the current remuneration with flat rates for treatment cases. In the future, clinics should receive 60 percent of the remuneration for providing certain offers. The project is highly controversial – before the vote, critics again called for it to be stopped.

“A hospital reform was and is the right thing to do. But the draft as it is now available cannot be implemented,” said the deputy chairwoman of the German Hospital Association, Henriette Neumeyer, to the “Rheinische Post”. “The hospital locations that are needed are also not secured by the law.” The draft stands for “a continued cold market shakeout with the disappearance of hospital locations and the introduction of rationing and waiting list medicine”.

The board of the German Patient Protection Foundation, Eugen Brysch, also warned that MPs could not estimate the effects. “There was never a stress test that the legal project went through in practice,” he told the “Rheinische Post”. The reform is poorly done and there are fears that rural areas will continue to bleed dry. “After all, it is still unknown which hospitals will be responsible for people’s respective illnesses.” Financing also remains “largely unclear, even for the transition period.”

Many clinics are in the red

There are around 1,700 clinics in Germany – the Ministry of Health speaks of the highest hospital and bed density in Europe. However, many beds are not occupied and many clinics are in the red. The reform is intended to bring more specialization and less bureaucracy.

The new payment system is intended to reduce the financial pressure on the clinics and prevent them from carrying out medically unnecessary operations for reasons of revenue. The basis for financing by the health insurance companies should be “performance groups”. They should describe the respective clinic treatments in more detail and ensure nationwide quality standards. The concrete implementation of the reform should take place step by step over several years.

The SPD health expert Heike Baehrens told the German Press Agency that the most comprehensive health reform of the past 20 years sets the course for a modern hospital landscape in Germany. “For citizens, this means assured quality of treatment and reliable access to medical care close to home.”

Criticism has been coming from the hospital industry and the opposition for months. Statutory health insurance companies welcome more specialization, but warn of further cost increases.

Bavaria wants to enforce the mediation committee

The states have also raised objections. However, Lauterbach no longer designed the law in such a way that it requires approval in the subsequent discussion in the Federal Council. However, the state chamber could call the mediation committee with the Bundestag and thus slow down the reform.

This is what the Bavarian Health Minister Judith Gerlach is striving for: “Bavaria will advocate in the Federal Council for the intervention of the mediation committee in order to bring about the urgently needed changes in this way,” said the CSU politician to the “Augsburger Allgemeine”. “Smaller hospitals, especially in rural regions, will have difficulty maintaining their current range of services due to the rigid and fragmented requirements.”

Lower Saxony’s Health Minister Andreas Philippi, on the other hand, expressed himself more optimistically after the SPD politician had long criticized: “It’s clearly going in the right direction. A lot has improved through our negotiations,” he told the German Press Agency. However, Philippi again demanded more money from the federal government for the clinics. He left Lower Saxony’s voting behavior in the Federal Council at the end of November open. In addition to the provision of money, the decisive factor is whether an impact analysis shows clear advantages for Lower Saxony.

Barmer boss sees too many concessions to countries

The CEO of the Barmer health insurance company, Christoph Straub, criticized the fact that too many exceptions had already been made due to pressure from the federal states. “In the meantime, the reform has been so watered down that I say: better no reform than this reform,” he told the editorial network Germany (RND). “A reform that costs those paying contributions a lot of money but does not bring any better quality is fatal and should not happen under any circumstances. The traffic light coalition should bury its plans and give the successor government the chance to do better with a new attempt.”