Germany: The federal and state governments agree on the concept of …

The reform, which aims to stave off chronic financial pressures, is “a kind of revolution” for hospitals. Currently, 14 out of 16 countries have agreed to this concept.

After weeks of disagreement, the federal and state governments in Germany have agreed on the basics of reorganizing clinics in Germany. Federal Health Minister Karl Lauterbach (SPD) said after joint consultations in Berlin on Monday that it was possible to agree on very detailed key points. Reform is “a kind of revolution.” Hospitals are no longer obliged to provide as many services as possible.

The best quality for patients must be ensured and made transparent. 14 out of 16 countries have agreed to this concept. A bill is expected to be drafted over the summer. The reform is scheduled to enter into force at the beginning of 2024.

The state’s chief health minister, Mann Lucha (the Greens) from Baden-Württemberg, stressed the principle of “the right offer in the right place” – this also avoids “born losers” between clinics. The common goal is to have consistent quality in operations “in Bottrop and Buxtehude and in Hamburg Barmbek,” said Melanie Schlotzhauer, a senator for Hamburg. The repair will take the pressure out of the system. Karl Josef Lehmann, head of the North Rhine-Westphalian Department (CDU), said he was “really happy” to take advantage of the window of opportunity for reform. Two countries did not agree on the main points – Bavaria voted in the negative and Schleswig-Holstein abstained.

What needs to be changed?

• Compensation: Reform plans envisage changing the long-controversial system of compensation with lump sums for treatment cases. This is intended to free hospitals from economic pressure and the “hamster wheel,” as Lauterbach explained — that is, from squeezing more and more cases, and sometimes also interventions for which there isn’t a lot of experience. Therefore, in the future, there should be a large percentage of the pay just for making service offerings themselves.

• Division of tasks: The basis for funding by health insurers in the future should be more specific to service groups – eg ‘cardiology’ rather than rough terms like ‘internal medicine’. For this, standardized quality specifications must be met, for example in terms of equipment, personnel and treatment expertise. This leads to the concentration of more complex treatments, such as cancer, in specialized hospitals. Small clinics can focus on what they’re particularly good at, Lauterbach explained, caring for simple cases.

• Transparency: Lauterbach also plans a “transparency law” and wants to publish data on the quality of treatment in all clinics as patient information. The federal government wants to implement this by January 1, 2024. The distribution of packages of services in clinics and the division of the network into “tiers” must be transparent – from basic care close to home to second tier with other offerings up to extreme care providers such as university clinics. The federal states had previously rejected a more direct role for these levels in reform.

• Timeline: Hamburg, Baden-Wurttemberg, North Rhine-Westphalia, and Mecklenburg-Vorpommern, East Germany, will take part in drafting the law. Lauterbach said the timetable is set for the reform to take effect on January 1, 2024. Concrete implementation in clinic budgets should only gradually take effect in the following years.

• Finances: Recently, there has been a struggle over demands from the federal states for an additional injection of funds from the federal government in light of the severe financial difficulties of many clinics. Lauterbach also said, in terms of budgeting, that this would be checked, but immediately added: “I can’t hope for that.” Unfortunately, clinics will still go bankrupt until the reform goes into effect – but that’s because the reform was not done earlier.

Bavarian Health Minister Klaus Holicike (CSU) criticized the main points as insufficient. The vote against Bayern was not a “no” position. The German Hospital Association complained about the lack of security planning and warned: “The wave of insolvency is deteriorating and care will deteriorate”. The head of the Techniker Krankenkasse, Jens Bass, spoke of “a big step for more quality hospital care”. Representatives of the coalition factions in the federal government also participated in the deliberations. (APA)