Compensation system is changed
Associations call for financial commitments for hospital reform
7/11/2023 3:56 am
After long negotiations, the federal and state governments agree on the basics of a hospital reform. But the dispute is likely to continue: trade unions and associations see a need for funding. Federal Minister Lauterbach would rather “not raise any hopes”.
After the federal and state governments agreed on the cornerstones of the hospital reform, trade unions and associations called for commitments to include financial injections for clinics. Such a transformation cannot succeed without significant investments, said the chairwoman of the Marburger Bund doctors’ union, Susanne Johna, to the “Rheinische Post”. “Anyone who thinks that the existing funds can simply be redistributed and surcharges can be granted in a few places and then it would all work out is, to put it mildly, naïve.”
Even the development of a hospital site requires financing, Johna continues. The rescue services would then have to bridge longer distances to individual locations, she pointed out. The chairwoman of the doctors’ union criticized the lack of technical equipment and staff here. This aspect has so far been completely ignored. The union leader also criticized “that the supposedly central goal of reducing bureaucracy has become a paper tiger.”
The plans, which the federal and state governments agreed on Monday evening, essentially provide for changing the remuneration system with flat rates for treatment cases in order to relieve hospitals from the financial pressure to deal with more and more cases. Therefore, they should receive a large proportion of the remuneration simply for providing services. In the future, 60 percent of the costs of clinics should be covered by flat rates, said Federal Health Minister Karl Lauterbach from the SPD.
Lauterbach “can’t raise any hopes”
The basis of the financing by the health insurance companies should be more precisely defined performance groups of the clinics – for example “cardiology” instead of rough terms like “internal medicine”. The performance groups are intended to ensure uniform quality specifications, for example in terms of equipment, staff and treatment experience. The smaller hospitals in particular should offer fewer services in the future and limit themselves to those interventions that they are good at. Over the summer, the federal and state governments want to draw up a concrete draft law that is to come into force on January 1, 2024.
In the run-up, there had already been a dispute over demands from the federal states for an upstream extra financial injection from the federal government. Minister Lauterbach said on Monday evening, also with a view to the budgetary situation, that this would be checked. He added: “I can’t get my hopes up on that.”
One of the central points for Lauterbach is a “transparency offensive”: Patients should be able to find out which ones with just a few clicks on the Internet quality standards a clinic meets in certain treatments and where there may be shortcomings. The data for this has been available for years: for ten years now, hospitals have been obliged to publish a quality report every year. However, patients who have to decide, for example, in which hospital they want to have cancer treated, cannot do anything with such reports. This decision can be of the utmost importance: Studies show that treatment in certified oncology centers increases the chance of survival for cancer patients. Patients are already finding about the “White list”, a project of the Bertelsmann Foundation, the best hospitals for their respective needs. The basis for this is the data from the quality reports and the results of patient surveys.
The central association of statutory health insurance companies (GKV) complained that the financial impact of the key points remained unclear. “The federal government has not made any specific financial commitments and the federal states are still not committed to financing the investment costs. This must not be at the expense of the contributors,” said Stefanie Stoff-Ahnis from the association’s board.
The German trade union federation praised the agreement in principle. However, further steps are needed to advance the structural reform in inpatient care. “It is also important to take the concerns of the employees into account,” said board member Anja Piel of the German Press Agency. Quality care for patients will only be possible if we succeed in persuading more specialists to stay.