The inadequate medical care of children and young people is causing great concern, and the next treatment gap may be just around the corner.
The German Hospital Society (DKG) and the Central Association of Statutory Health Insurance (GKV) fear that the precarious financial situation in the health system could lead to deficiencies in patient care.
There is "concern that necessary care structures will break down due to a lack of funding," says the common basic positions of the GKV association and the DKG on the short and medium-term need for action with regard to the financing and structures of the hospitals.
Christian Geinitz
Business correspondent in Berlin
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Responsible for the expected deficit are the benefits that have fallen since the pre-pandemic period and the expiry of the corona aid intended as compensation.
This includes in particular the “full-year compensation” from 2020 to 2022, which enabled hospitals to compensate for pandemic-related revenue declines in individual negotiations.
The position paper, which is available to the FAZ, warns of a "financial emergency" that could trigger "strong volume incentives".
This means that the clinics could be forced to treat as much as possible to compensate for their absences.
Pressure also on the countries
This effect would be in contrast to the recent reform proposals of a government commission for the reorganization of clinics.
In agreement with Health Minister Karl Lauterbach (SPD), this had suggested getting away from case flat rates, which encouraged clinics to bill as many profitable services as possible, often bypassing actual necessity.
The DKG and the National Association of Statutory Health Insurance Funds welcome the core of the reform project.
"There is a general consensus on the goals to be achieved through reforms," the text says.
The efficiency of the supply must be increased in order to cover the growing demand - also due to the aging of society - and at the same time to guarantee that it can be financed.
However, the two associations are urging that, in addition to the federal government, the federal states also commit to the goals and make the necessary funds available;
up to now, they have often refused to invest in the clinic, although they are responsible for it.
A smooth interaction of nationwide incentives and conditions with the regional supply needs is also necessary.
This also applies to the performance-independent provisional financing, which is intended to replace large parts of the remuneration with case flat rates.
"Almost every tenth employee is ill"
In addition, there is the need for "a relevant proportion of previously inpatient treatments... to be treated on a clinical-outpatient basis in the future," according to the basic positions.
Lauterbach's "great hospital reform", which he called a revolution, is designed for the medium and long term.
The transition period should be five years.
For the two associations, this planning is not going fast enough with a view to the financial situation "after Corona".
The feared undesirable developments must be prevented by "appropriate measures" as early as the new year 2023, they demand.
In the current situation with the high wave of respiratory infections, the DKG also warns of staff shortages in the clinics.
Association leader Gerald Gaß told the German press agency: "Almost every tenth employee is ill." The absences of medical and nursing staff are 30 to 40 percent higher than usual at this time.
If the personnel limits were not reached, the stations could not continue to work.
Gass called for the minimum staffing levels and certain documentation requirements to be suspended in order to act more flexibly and relieve the burden on employees.
In order to meet the shortage of certain medicines, the President of the German Medical Association, Klaus Reinhardt, called on the population to help each other out with medicine chests.
Solidarity is important, "if you are healthy, you have to give medicines that are in stock to the sick," he told the newspaper "Tagesspiegel": "We need something like flea markets for medicines in the neighborhood." Against the shortage, there is also the suggestion that pharmacists Make your own fever juices.
However, this costs more and is only paid for by health insurance companies if it is noted on the prescription.
However, the doctor does not know the availability when it is issued, the ABDA Association of Pharmacists complains.
Therefore, the regulation must be changed so that the pharmacies can decide whether they produce medicines themselves.
The Child Protection Association called on the government to centrally procure scarce medicines for minors.
"The ideology that the market regulates everything, even when it comes to the health of our children, is wrong," said association president Heinz Hilgers of the "Stuttgarter Zeitung".