Health Minister Karl Lauterbach (SPD) has set himself the task of reforming the health system.Image: dpa / Christophe Gateau
Germany
The major reform of the healthcare system is still a dream of the future. So far, experts have made suggestions as to what could be changed. It is clear that something has to change. The winter has shown how things are with the German clinics: in parts so bad that not even children can be cared for.
The expert panel’s proposals promise change: Centralization, outpatient care, new funding. But what do the plans mean for patients? Watson spoke about this with the health economist Andreas Beivers from the Fresenius University of Applied Sciences in Munich.
Duration of the hospital stay is strictly regulated by case flat rates
One point that Health Minister Karl Lauterbach (SPD) should address – at least from the point of view of the experts – is the financing of the clinics. The current system is the so-called flat rate per case. The health insurance companies pay fixed prices for fixed clinical pictures and treatments. The criticism of it: the bloody discharged patient. Because not only treatment and payment are regulated with the flat rate, but also the duration of the hospital stay.
The situation in the clinics is tense.Image: dpa / Marijan Murat
New funding is needed
“The flat rate per case can not do anything for the negative effects,” says Beivers. It’s just being misapplied. “In Germany, the approach is that the hospitals should be financed solely by the flat rate per case and thus end up in a hamster wheel. Those who operate a lot earn a lot of money,” summarizes the economist.
Lauterbach wants to change that. The expert commission has come out in favor of a 40/60 solution. 40 percent of the money should still come in through case flat rates, 60 percent through so-called upfront costs. In other words, money that is put into the clinics without acute treatment. In this context, the Minister of Health spoke of the de-economy of the clinics.
An expression that annoys Beivers. The economist would prefer Lauterbach to speak of decommercialization. He clarifies: “Economics is the science of managing scarce resources.”
In concrete terms, this means using resources where they are most useful and not wasting resources. “Economy means: We have scarce financial and human resources, or even scarce medicines – and we have to make sure that we use all of this as well as possible,” Beivers makes clear. However, Lauterbach was right in moving away from the obligation to maximize the number of cases and thus the revenue of the hospitals in order to be able to survive economically.
Minister of Health Lauterbach has already initiated a first small reform, the big one is to follow.Image: imago images/ chris emil janssen
Health is a national matter
In addition to funding from the health insurance companies, health is a matter for the federal states. Means: The federal states have to loosen budgets for the health system and the clinics. From the point of view of the clinics, however, too little is happening here. Burkhard Rodeck, for example, explained when asked by watson: “For decades, hospitals have only received just under half of the funds they need.” He is Secretary General of the German Society for Child and Adolescent Medicine (DGKJ) and calls on the federal states to do something about it.
und this despite the fact that healthcare expenditure is increasing every year. “There is no saving on the hospitals,” says Beivers. Nevertheless, the clinics are underfunded. So where is the money going? In inefficient structures, the health economist is convinced. Too many procedures are performed on an inpatient basis when outpatient care would suffice.
A grievance that Lauterbach also wants to address. And with the upgrading of outpatient care, an old advance should also come back onto the agenda: centralization.
Centralization against the shortage of skilled workers
Centralization, Beivers clarifies, is not a bad thing. Even if many people in rural areas start thinking about their medical care just by naming the word.
However, centralization does not mean that all district hospitals have to close, says Beivers. Rather, it is a question of distributing skilled workers and skills sensibly and fairly. keyword economy.
The devices that clinics need to care for patients are very expensive.Image: dpa / Marcus Brandt
In concrete terms, this means that staff are pooled in large clinics, while the smaller and medium-sized hospitals could get by with fewer staff for the simple reason that not so many treatments are carried out there. Instead, they could take care of the aftercare of patients.
In the practical example, this would mean that the fictitious patient Monika Maier from Höchst in the Odenwald will in future be operated on in Aschaffenburg or Darmstadt, while her follow-up care will take place in the Erbach district hospital. So her family can visit her without having to travel far.
That sounds complicated, but it is necessary, says Beivers. The small and medium-sized hospitals would hardly be profitable. The costs for the expensive equipment that had to be provided are too high. Just like the costs for the large number of specialist staff who require 24-hour availability.
Beivers says:
“Of course, centralization alone cannot solve the problem of a shortage of skilled workers – but it can be assumed that the larger facilities can then be better equipped. This could make the rosters more pleasant and the profession would become more attractive.”
However, these facilities need highly modern and complex equipment – and they are very expensive. Germany would not save with centralization, but the quality would increase.
Plans could lead to problems
But the shot can also backfire, says Beivers. And that is if, in addition to outpatient care in the central clinics, no thoughts were given to aftercare and case management. So the coordination of the individual care of patients.
Case management also includes ensuring that patients receive follow-up care.Image: 5vision.media/dpa
It would not help anyone if patients were simply shown the door after their outpatient hearingwithout knowing what the personal circumstances of the person are.
Back to the fictional example of Monika Maier from the Odenwald: If she has been treated as an outpatient in Aschaffenburg or Darmstadt, she has to go back to the Odenwald somehow. Does she have children, a partner? In short: can someone look after you and pick you up after the treatment? These are questions that clinics must answer.
Crisis is more than an early warning system
“If I bundle complex care, I need a network that takes care of aftercare. That doesn’t exist today, so we have to think about how many old hospitals can be part of this network?” Beivers continues. So what will also be needed in the future: medical and nursing care in the regions.
It is about converting many of the district hospitals instead of closing them. Be it in small specialist clinics or monitoring clinics. It must not happen, believes Beivers, that the system is transformed in such a way that everyone in the country has to travel far to get any supplies.
The current deficiencies, which are popping up everywhere, are more than an early warning system. “Our system is not designed for future challenges,” says Beivers. So it is high time to tackle the problems.
And the reform will come, the economist is convinced of that. In the end, both the clinic staff and the patients can benefit from this.
