2023-07-13 15:12:38
Karl Lauterbach dares superlatives. The Federal Minister of Health called ” revolution ” the agreement reached on Monday July 10 with the German regions to reform the hospital system. No more fee-for-service, the country’s 1,800 hospitals will soon receive fixed funding that will cover nearly 60% of their budget. “They will no longer be forced to do as many acts as possible to finance themselves. This will remove economic pressure and help de-bureaucratize clinics,” welcomed the Social Democrat Minister, himself a doctor by profession, presenting his roadmap negotiated for weeks.
This reform is in line with what France is also considering. In January, President Emmanuel Macron announced a health plan that plans to put an end to fee-for-service pricing in hospitals. On the other side of the Rhine, this funding system, associated with a drop in investment by the regions – responsible for health issues – had resulted in an increase in lucrative acts, sometimes of little medical use, in conditions that were not always optimal.
Declining number of establishments
One of the other objectives of this reform – the text of the law will be presented at the start of the school year – aims to raise the level of quality of care by setting up national criteria. Each establishment will also be assigned groups of services according to the quality of its equipment and staff, which will reinforce specialization. The solution is hailed by associations fighting against cancer, which already advise patients to turn to large specialized centers. More controversially, the minister also wants to pass a law imposing a transparency register that would allow patients to know the levels of excellence of each establishment by activity.
One of the expected consequences of this reform is the decline in the number of establishments, a phenomenon already underway due, among other things, to the chronic lack of medical personnel. “We have 1,719 hospitals for which we already do not have enough nursing staff”, found Karl Lauterbach. For the Minister, the closure of establishments is a blessing in disguise, if “with 20% fewer hospitals, the supply of care is improving”. The association of German hospitals is concerned, however, about this disappearance “uncontrolled” one in four establishments over the next seven years.
Bavaria’s refusal
In general, representatives of the sector are worried about not being offered an additional budget to accompany these restructurings, at a time when clinics and hospitals are already weakened by inflation. The federal minister has promised to ask his finance colleague for an extension, but without guarantee of success. Berlin has imposed itself to return to a balanced budget next year.
Nor is it obvious that this reform will save money when the German healthcare system is one of the most expensive in the world. Germany has by far the most beds per number of inhabitants, which has enabled it to weather the pandemic period relatively well.
As for the most rural regions, they should obtain exemptions in order to maintain a fairly wide healthcare offer. Insufficient, however, in the eyes of Bavaria, the only region to have refused the roadmap negotiated on Monday.
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