Federal Health Minister Karl Lauterbach wants to present fundamental reform proposals for the future of hospitals in Germany today. The declared goal is to free care more from financial pressure.
For this, the previous remuneration for flat rates for treatment cases should be changed significantly, as the SPD politician had already announced. A commission of experts from the federal government has drawn up recommendations on this. The Bundestag recently passed an initial package of laws that, among other things, provides for more money for children’s hospitals.
The German Hospital Society called for an overall concept for a reform. “The constant detachment of individual solutions brings more distortions than progress in the system,” said CEO Gerald Gass, the newspapers of the Funke media group. First of all, the financing gap in the operating and investment costs of the clinics must be closed before the funds can be redistributed.
Lauterbach: Current system emphasizes “cheap and quantity”
Lauterbach had made it clear in advance that it was about “no less than a revolution” in the financing of hospitals. “We have lost the balance between medicine and economics,” he said in the Bundestag last week.
The current system emphasizes “cheap and quantity”. In clinics, however, one cannot proceed with the same rules as with food discounters.
In essence, it should be about “overcoming” the case-based flat rates. According to Lauterbach’s analysis, the system has now become so independent that it is at the expense of the quality of care. This is due to a “hamster wheel effect”: clinics can only maintain or increase their budget by increasing the number of cases. And clinics made a profit that spent as little money as possible on services – higher expenses, on the other hand, tended to mean losses.
“In fact, the hospitals are not doing well at all,” said the SPD politician on Tuesday on Deutschlandfunk, referring to the system of flat rates per case. They offer a systematic incentive for the clinics to “go into the crowd” and often do too much. The quality suffers as a result. Lauterbach spoke of an imbalance between medical and economic aspects.
The remuneration via case flat rates was introduced almost 20 years ago in order to make the system more efficient and, for example, to shorten hospital stays for patients. There is a catalog with case and diagnosis groups for this.
More patients, more income
The clinics then receive a lump sum in euros from the respective health insurance company per patient or treatment case, as explained by the Central Association of Statutory Health Insurance Companies (GKV). The more patients a clinic treats, the more revenue it generates. Costs for nursing staff have already been removed from the flat rates in order to eliminate the pressure to save on nursing. The cash registers pay all costs incurred.
Overall, the expenses for the nationwide around 1900 clinics make up the largest individual item in the statutory health insurance. According to the National Association of Statutory Health Insurance Funds, almost 85.9 billion euros were incurred last year – and thus around one in three euros in relation to the total benefit expenditure of 263 billion euros.
In general, the financing of the hospitals is divided into two parts: the operating costs including staff are paid by the health insurance companies, investment costs such as for new buildings or new equipment are to be financed by the federal states.
