Lauterbach’s critics see supply in danger
Bevor the federal and state governments this Thursday for the first time officially on the planned hospital reform from the Federal Minister of Health Karl Lauterbach (SPD) speak, the topic is already making waves. Bavaria’s Health Minister Klaus Holetschek reminded on Wednesday that according to the Basic Law, the federal states are responsible for hospital planning: “This sensible regulation must not be undermined by the Berlin traffic light coalition.” The latest ideas interfered “in an unreasonable way with the competence of the federal states”.
The CSU politician referred to the proposals of a commission of experts that Lauterbach had set up. Among other things, these envisage a partial departure from remuneration based on case flat rates and instead the introduction of provision services regardless of the number of patients.
Hospitals are to be divided into three categories (levels of care) depending on their performance, and their services are to be assigned to different performance groups based on their qualifications and equipment. The latter should lead to a bundling of competencies so that not every house offers everything.
Beware of a “quasi-planned economy” system
Holetschek criticized that the concept amounts “to a centrally controlled, quasi-planned and highly theoretical system that would endanger the necessary supply structures on site”. There must continue to be well-equipped and adequately financed clinics in the area.
“About the supply needs with hospitals decisions in the state must not and cannot be made from the Berlin desk.” As an example, Holetschek cited the 33,000 births that are currently being cared for in smaller hospitals in Bavaria. According to Lauterbach’s conception, they could “in future only take place in larger hospitals”.
The federal government is responsible for setting the framework for ongoing hospital financing, the federal states have to make the investments, but in the opinion of the federal government they do not fulfill this responsibility. According to Holetschek, 15 billion euros are missing every year to cover the operating costs, which the federal government must now raise as “special financing”.
Instead of doing that, Lauterbach’s reform amounts to a redistribution of inadequate resources. “The decisive factor will be whether Lauterbach succeeds in convincing Finance Minister Lindner that significantly more funds are required,” said the Bavarian.
Criticism from the German Hospital Society
The allegedly tight finances are also causing concern for the German Hospital Society (DKG). The commission’s calculations were based on a “false basic premise”, criticized the DKG chairman Gerald Gass: “According to the commission’s idea, the reform should only redistribute the current funds.”
The system urgently needs fresh money, 60 percent of the clinics expect “some deep red numbers” for 2022. In the new year, the costs are likely to increase twice as fast as the state-determined remuneration. Gass warned of a hospital death that “is expected to reach a new peak this year”.
According to the Commission, there will be three categories of clinics in the future: nursing-oriented basic care and emergencies, those for standard and priority care, and “maximum care providers”, mostly university institutions. “Large hospitals in urban centers will prevail, small ones in the country will fall by the wayside,” fears the head of the German Foundation for Patient Protection, Eugen Brysch.
“The bleeding of medical care in the region must be prevented by a hospital reform,” he told the “Rheinische Post”. Brysch also insists on better financial resources: “Especially in rural areas, people need tailor-made offers for stroke, heart attack, cancer therapy and geriatric medicine. This will undoubtedly cost money.”
The social association VdK rates Lauterbach’s plans as a “step in the right direction”. In the future, only 60 percent of the running costs would be billed via the case flat rate, the rest via the fixed remuneration as “upfront flat rates”. The reclassification of the clinics into different levels of care ensures basic care in rural areas. Supplementing inpatient with outpatient care benefits older patients. However, the reform will not be enough, said VdK President Verena Bentele: “We call for a complete departure from the profit orientation and the so-called flat-rates per case in the remuneration system.”