After a heated Federal Council meeting
What effects the hospital reform has
Updated 11/22/2024Reading time: 3 min.
Minister Lauterbach is achieving his prestige project despite the break in the traffic light coalition: after much wrangling, a realignment of the clinics has been decided. But what dose that mean exactly?
After almost two years of struggle for a major hospital reform, Karl Lauterbach has pushed through his prestige project. The Federal Council passed the draft so that the law comes into force on January 1st.
There were always heated discussions in advance, which continued into the crucial Federal Council meeting.Brandenburg’s Prime Minister Dietmar Woidke (SPD) fired Health Minister Ursula Nonnemacher (Greens) in the current meeting before the vote came. The Thuringian government was divided, so the votes from the Free State were invalid.Read more about it here.
The goals of the reform: less financial pressure on clinics and more specialization in more complex procedures should lead to better care for patients. t-online answers the most important questions about the reform.
According to experts, there are a relatively large number of clinics in Germany compared to neighboring countries – and these have had simmering problems for years: financial difficulties, staff shortages, and a third of the 480,000 beds are not occupied, according to the Ministry of health.Lauterbach sees the reform as a kind of emergency brake: without changes there is a risk of clinic insolvencies and suboptimal treatment.
It is clear that Germany has neither the medical needs nor the staff for 1,700 hospitals. The aim is therefore to ensure that the houses that are really needed have an adequate economic basis.
The remuneration system introduced 20 years ago with flat rates per treatment case is to be fundamentally changed. According to Lauterbach, it has so far led to a “hamster wheel effect” in which clinics try to get as many cases treated as possible in the most cost-effective way possible – or even to incentives for medically unneeded interventions.
In the future, there should be a fixed base of 60 percent of the remuneration simply for the fact that clinics have a basic set of staff and equipment for certain services. The rest should continue to be financed through flat rates per case. There should be additional payment surcharges for clinics with pediatrics,obstetrics,intensive care and accident medicine,special stroke wards and emergency care.
What does the reform provide for treatment quality?
The new fixed remuneration is to be given to a clinic for “performance groups” that the state assigns to it. They represent medical services in a more precise manner than roughly named specialist departments. The starting point should be 65 groups, which are largely based on a model from North Rhine-Westphalia – such as “spinal surgeries” or “leukemia”.
A hospital must meet certain quality criteria to receive a performance group, such as in terms of specialist staff and equipment. Lauterbach repeatedly made it clear that he did not want to make any compromises. This is intended to ensure that cancer treatments, for exmaple, are carried out in clinics with the necessary specialist knowledge.
The states responsible for hospital planning should control the change. You could say, for example, whether there are two or four locations for spine surgery in a region, explained Lauterbach. The new fixed compensation is also intended to secure the continued existence of smaller houses in the countryside.
The federal states should also be able to declare locations as “cross-sector care facilities” that combine inpatient treatment with outpatient and nursing services “close to home”. Where there are no specialist and general practitioner practices, patients should be able to go to hospital for these treatments in the future. Clinic locations are likely to be eliminated, especially in major western German cities.
How will teh restructuring of hospital financing affect patient care in Germany?
Time.news Editor (T.E.): Welcome to our interview on the meaningful hospital reform passed by the Federal Council. today, we have with us Dr. Emily Klein, a health policy expert with extensive experience in healthcare systems. Thank you for joining us, Dr. Klein.
Dr. Emily Klein (E.K.): thank you for having me. I’m excited to discuss this reform and its implications for the healthcare landscape in Germany.
T.E.: The recent meeting of the Federal Council has garnered a lot of attention, particularly due to the heated discussions surrounding the reform. What prompted this urgency for reform in the hospital sector?
E.K.: The urgency stems from several critical issues. Germany has a high number of hospitals relative to its medical needs, with 1,700 facilities, many of which are underperforming. There are financial difficulties, staffing shortages, and about a third of hospital beds are currently unoccupied.Health minister Karl Lauterbach described the reform as an “emergency brake” to prevent insolvencies and ensure better treatment outcomes.
T.E.: Lauterbach has described the situation as a crisis. how does this reform aim to address the financial pressures that hospitals face?
E.K.: The reform intends to alleviate financial pressures by restructuring hospital financing and shifting the focus from quantity of treatments to quality of patient care. Currently, the flat-rate remuneration system incentivizes hospitals to churn through cases rather than provide optimal care, leading to what Lauterbach terms a “hamster wheel affect.” The new changes are designed to create sustainable economic foundations for the hospitals that are truly necesary.
T.E.: Interesting! You mentioned specialization in complex procedures. What role does specialization play in this reform?
E.K.: Specialization is crucial for improving patient outcomes. By encouraging hospitals to focus on specific areas of expertise, the reform aims to enhance the quality of care for complex medical procedures.This concentrated approach can lead to better-trained staff, improved equipment, and more efficient use of resources—ultimately benefiting patients who require specialized care.
T.E.: There has been some controversy in the lead-up to the passing of this reform, especially with divisions within the political landscape. How do you think this impacts the implementation of the reform?
E.K.: Political fragmentation can complicate implementation. The fact that this reform passed despite the dysfunction within the traffic light coalition suggests a strong consensus on the necessity for change. though, if there is ongoing discord, it may hinder subsequent phases of the reform or lead to shifts in priorities that can affect its original intent. There needs to be continued dialogue among stakeholders to ensure its success.
T.E.: What are the anticipated challenges as hospitals adapt to these new regulations?
E.K.: One major challenge will be the adjustment of the hospital workforce and management systems to comply with the new remuneration framework. Training staff to focus on quality rather than quantity will require time and resources. Additionally,some hospitals may resist the changes,especially those that currently operate under the old system and have successfully navigated it. Continuous support and engagement from the Ministry of Health will be crucial during this transition.
T.E.: What do you think are the long-term outcomes if these reforms are successfully implemented?
E.K.: If implemented effectively, we coudl see a more efficient healthcare system that prioritizes patient care over mere profitability. Ultimately, this could lead to improved health outcomes, reduced financial strain on hospitals, and a more sustainable healthcare surroundings in germany. A prosperous reform could also serve as a model for other countries facing similar issues in their healthcare systems.
T.E.: Thank you,Dr. Klein, for your insights on this crucial topic. The hospital reform certainly represents a significant shift in Germany’s healthcare strategy,and it will be interesting to see its effects in the coming years.
E.K.: Thank you for having me! I’m looking forward to seeing how the situation progresses and the impact it has on patient care in Germany.