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Federal Health Minister Karl Lauterbach
Photo: CHRISTIAN MANG / REUTERS
Federal Health Minister Karl Lauterbach (SPD) presented the results of the government commission for hospital reform.
"The problem has been known for at least ten years and it has never been fundamentally addressed," Lauterbach said of the system's funding.
That is why his reform is "a revolution that we absolutely need."
The serious problems in hospitals can currently be seen in the situation in children's hospitals, Lauterbach said at a press conference.
The minister pinpoints the main problem of the hospitals in the system of flat rates per case, the so-called DRGs, which he partly helped to introduce.
That sends the incentive to treat individual cases as cheaply as possible in order to make a profit.
Hospitals could only earn more by treating more cases, which would put them on a hamster wheel.
He knows senior doctors who have left the hospitals because of the economic pressure.
Lauterbach had long argued that he wanted to abolish the flat rate per case entirely.
However, there was no majority in the coalition for this, and some experts were also critical of it.
In the Commission's recommendations, the flat rates are now at least reduced.
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The rough assignment of specialist departments to hospitals should be replaced by more precisely defined service groups, explained Commission President Tom Bschor.
For example, “internal medicine” is very diverse – even a small, poorly equipped department can handle everything from acute heart attacks to complex cancer treatments.
Instead, new service groups should stipulate that only those clinics that are really familiar with such treatments and have the necessary equipment can bill them.
As an example, Bschor cited the new department for leukemia and lymphoma.
In its 49-page recommendation, the Hospital Commission proposes defining a fixed amount as upfront costs that hospitals receive depending on their assignment to a specific category.
This is intended to take economic pressure off the hospitals.
Caregivers should also run care centers
In the future, hospitals are to be classified into three specific levels:
Primary Care – Basic medical and nursing care, such as basic surgeries and emergencies.
Regular and Specialized Care – Hospitals that offer additional services compared to basic care.
Maximum care - such as university hospitals.
The hospitals of the first level should be planned regionally and be able to work on an outpatient and inpatient basis.
They are to be divided into those that are to have an emergency room and outpatient-inpatient centers.
Under certain circumstances, they should also be able to be managed by nursing staff, not just by doctors, and be completely removed from the DRG system, explained Bschor.
In this way, every patient will get the right offer in the future, said the President of the German Society for Internal Intensive Care Medicine and Emergency Medicine Christian Karagiannidis, also a member of the commission.
In the future, a cancer patient must be treated in a certified oncological center.
Lauterbach now has to implement the commission's recommendations in a legislative initiative.
The minister has already taken the first steps towards reform with a reform of children's clinics and maternity wards, which was passed last week.
The Commission also wants to work on further recommendations.
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