Hospital reform
What the major operation brings to the clinics
Updated 10/17/2024 – 4:54 p.mReading time: 4 min.
The name says it all: The “Hospital Care Improvement Act” clears the most important hurdle in parliament. This involves a longer renovation. What does this mean for patients?
The start began on St. Nicholas Day 2022, when a commission presented recommendations. Almost two years later, the Bundestag decided on a fundamental reorganization of clinics in Germany. Health Minister Karl Lauterbach (SPD) speaks of a “revolution” and the biggest reform in 20 years. The goals: less financial pressure and more specialization for more complicated procedures. But the plans are far from undisputed. What does the major operation mean for the patients?
According to experts, Germany has too many clinics compared to neighboring countries. There are big problems: financial difficulties, staff shortages, and according to the Ministry of Health, a third of the 480,000 beds are not occupied.
Lauterbach sees the reform as an emergency brake: without changes there is a risk of hospital insolvencies, poor treatment and long journeys. It is clear that Germany does not have the medical needs or the staff for 1,700 hospitals. The aim is therefore to ensure that the houses that are really needed have an adequate economic basis.
Clinics currently receive a flat rate per patient or treatment case (flat rate per case). According to Lauterbach, this leads to a “hamster wheel effect” of doing as many treatments as possible in the cheapest possible way, or even creates incentives for unnecessary treatments. A popular example is the knee prosthesis, which is installed where it may not even be necessary.
According to the draft law, there is also a risk that some clinics will carry out difficult treatments for which they lack the experience or will no longer offer supposedly less lucrative medical services.
The per-case remuneration system introduced 20 years ago is to be fundamentally changed. 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, regardless of the number of cases.
The fire brigade is not only paid when there is a fire, argued the commission that developed proposals for the reform. There should be extra remuneration surcharges for clinics with pediatrics, obstetrics, intensive care and accident medicine, special stroke wards and emergency care.
What should be done about the quality of treatment?
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”.
Uniform quality specifications for specialist personnel and equipment are also defined. Lauterbach repeatedly made it clear that there were no compromises to be made. This is intended to ensure that cancer treatments, for example, are carried out in clinics with 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 retention allowance is intended to secure livelihoods, especially for smaller houses in the countryside. In general, quality criteria should also be met in collaborations.
The states should also be able to declare locations to be “cross-sector care facilities” that combine inpatient treatment with outpatient and nursing services “close to home,” as the draft states. In areas where there are no specialist and family doctor practices, patients should be able to go to hospital for such treatments in the future.