Hospital reform passed
Where there is a risk of hospital death
Updated 10/17/2024 – 4:27 p.mReading time: 3 min.
The controversial hospital reform was passed in the Bundestag today. What is behind the law that Lauterbach touts as the biggest reform of the last 20 years?
For two years, the traffic light coalition has struggled for a decisive health care reform – the “Law to improve the quality of care in hospitals and to reform remuneration structures”, which Federal Health Minister Karl Lauterbach (SPD) presented this Thursday. What does that mean?
Germany has 480,000 hospital beds, a third of which are unoccupied, according to the Ministry of Health. According to experts, the Federal Republic therefore has too many clinics. There is a lack of staff, 30 percent of the 1,700 clinics are in the red and are therefore at risk of bankruptcy. Greater specialization should provide a remedy.
What is the current status?
So far, the so-called flat rate per case has applied: Clinics receive a flat rate per patient or treatment case. According to Lauterbach, this leads to a “hamster wheel effect” of carrying out as many treatments as possible as cheaply as possible. There are even (dis)incentives for unnecessary treatments.
Another possible effect: Some clinics would no longer carry out difficult treatments for which they lack the experience or would no longer offer less lucrative medical services – an effect of the economization of the healthcare system.
Instead of the system of flat rates per case, in the future there should be a fixed base (fixed remuneration or maintenance fee) of 60 percent simply for the fact that clinics have a basic set of staff and equipment for certain services, regardless of the number of cases. The remaining 40 percent will continue to be billed via flat rates per case.
Smaller hospitals in particular should offer fewer services in the future and limit themselves to those procedures that they are good at. This means longer journeys for patients, but they should also receive better treatment. However, some clinics should even receive additional funding for important core areas: pediatrics, obstetrics, stroke treatment, traumatology and intensive care medicine.
The law divides the other individual types of treatment into 65 service groups – such as heart surgery, leukemia or intestinal transplantation. The state authorities decide which hospital will be allowed to offer which service groups in the future. The basis is a certain, consistently comparable level of quality and proof of sufficient staff. Only then will they be paid for the treatment.
- The so-called Clinic Atlas provides information about current services and the quality of treatment in the 1,700 hospitals. You can find more information here.
Yes, many clinics are already facing bankruptcy; Lauterbach explained that he wanted to limit hospital deaths. “If in the end there are 20 percent fewer hospitals, but they offer better care, then that’s right in my opinion.”
A series of regulations are planned that are primarily intended to help small clinics in rural regions: specialists there should also be able to offer their services on an outpatient basis in the future. This eliminates the long journey to a specialist practice, which is often the case.
In addition, so-called safe houses in rural regions, which are indispensable for basic care, are allowed to deviate slightly from the strict quality requirements of the service groups.
Some federal states want to block the law in the Bundesrat and appeal to the mediation committee. They are skeptical that it can stop hospital deaths, especially in rural areas.
A transformation fund is intended to cover the costs for ten years – half financed by the states and the statutory health insurance companies. They are also up in arms against this regulation.
The board of the German Foundation for Patient Protection, Eugen Brysch, explained in the “Rheinische Post” that the reform was poorly done and there is a fear 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.”