Health Minister Karl Lauterbach’s controversial hospital reform has cleared the first hurdle. FOCUS online explains what is specifically planned and what is now changing in clinical care in Germany.
On Wednesday, the Federal Cabinet approved Federal Health Minister Karl Lauterbach’s (SPD) bill for clinic reform. With this, Lauterbach wants to fundamentally change the financing, organization and range of services of the around 1,900 hospitals in Germany.
A key goal is to improve the quality of treatment by no longer allowing every clinic to do everything, but instead having to demonstrate the minimum structures of medical experience, personnel and technology necessary for a service. Only then will the clinic be assigned a corresponding service group and be allowed to bill for the service. This should reduce the number of hospitals and ensure more large clinics.
The financing of hospitals should also change so that the clinics are freed from the financial pressure of having to treat more and more patients. In the future, they should receive 60 percent of the remuneration just for holding offers.
But what does this actually mean for your hospital stay?
With the new reform, all hospitals are no longer allowed to carry out complex operations. Patients then have to go to a special clinic for cancer surgery or difficult heart surgery. The background is that the costs in the healthcare system should also be reduced. Because when a specialist operates, the chances of recovery increase and the patient emerges from the spiral of illness more quickly.
According to Lauterbach, a third of cancer treatments are now carried out in two thirds of German clinics that are completely unfamiliar with it due to a lack of experience. The result is serious complications such as sepsis (blood poisoning). That should change now.
Long journeys to the clinic are not uncommon, especially in rural areas. According to the current Germany Atlas, patients now need at least 16 minutes to get to the nearest clinic. This is changing with the reform – massively. Patients should reach the nearest emergency clinic (internal medicine, trauma surgery) within 30 minutes. Specialist clinics should be reachable in a maximum of 40 minutes by car.
When planning, however, it is also important to take into account how many residents would be affected by longer travel times if there were no corresponding services in their area. The individual federal states are responsible for hospital planning.
This question is not easy to answer. At first glance it looks as if some clinics are actually closing. Although the reform envisages fewer hospitals, at least the quality in the remaining ones should increase. However, so-called Level 1i hospitals could still be needed in certain regions where many people would have to take longer journeys. They combine inpatient basic care services with outpatient specialist and family doctor services.
Lauterbach’s reform will “significantly change” the hospital landscape. So far there are “over-supplied cities” and “under-supplied areas” in rural regions, the draft says.
There is a lot of criticism of the planned reform from the health insurance companies and the federal states. The states accuse the Federal Minister of Health of wanting to indirectly centralize hospital planning through the quality standards.
However, hospital planning is the responsibility of the federal states. They fear that gaps in supply will arise, particularly in rural regions. Health insurance companies fear massive additional expenses and premium increases. In particular, they accuse the federal government of wanting to pass on the costs of redesigning the hospital landscape to contributors; However, health care is a public responsibility and must be shouldered by the taxpayer.
It is planned to use 25 billion euros from the health fund to support hospitals in Germany between 2026 and 2035. Converted, this means an additional annual burden on the health fund of 2.5 billion euros.
“These additional billions for the hospitals, which are to come from the health fund and directly from the health insurance companies, will consequently lead to increases in contribution rates,” said Florian Lanz, spokesman for the National Association of Statutory Health Insurance Funds, to the “Deutsche Ärzteblatt”.
Every euro that is spent additionally must be raised by the contributors,” said Florian Lanz, spokesman for the National Association of Statutory Health Insurance Funds, to the German Medical Journal. The contributors have to pay for every additional euro that is spent.