Karl Lauterbach (SPD)
In preparation for the consultations, Federal Health Minister Karl Lauterbach expressed confidence in the federal-state meeting.
(Photo: IMAGO/Chris Emil Janssen)
Berlin After months of negotiations, the federal and state governments reached agreement on common pillars for hospital reform. “It’s a kind of revolution,” Federal Health Minister Karl Lauterbach (SPD) said on Monday afternoon after the talks. “We are replacing the per-case flat fee system with the flat fee provision system.” Therefore, 14 federal states voted in favor of the project. Schleswig-Holstein abstained, Bavaria voted against.
In the future, clinics will receive money for offering services – even if they don’t actually perform them. “Hospitals are no longer required to provide as many services as possible,” said Lauterbach. The “economic pressure” is over.
Furthermore, only clinics that meet certain quality criteria — such as equipment and staff — would receive the flat fee. “Patients can be confident that treatments are needed and that complex services are provided in specialist centres.” This is to prevent clinics from offering operations without meeting the necessary criteria. However, the pillars also provide for exceptions here to “ensure national coverage”, as the newspaper puts it.
Lauterbach is also planning a “Transparency Act” under which data on the quality of care of all clinics will be published in 2024. The federal government will do this for itself. It is also intended to make clear the distribution of action groups and the division into levels of care.
Lauterbach warns of clinic bankruptcies
There was no agreement on a more controlling function of the levels. What is meant by tiers is the classification of the clinical network into tiers – from basic care close to home to a second tier with other offerings to ultimate care providers such as university clinics.
hospital
The aim is for the reform to take effect on January 1, 2024.
(Photo: dpa)
North Rhine-Westphalia Health Minister Karl-Josef Laumann (CDU) spoke of a “long road”. The federal and state governments first met a few weeks ago for consultations, and a deal had to be delayed due to criticism from the states. It assumes that the consensus in the Bundestag and Bundesrat will receive the necessary majority, Laumann said. Health Minister of Baden-Württemberg, Manfred Lucha (Greens), for his part, said that the details still need to be discussed.
The goal is for the reform to take effect on January 1, 2024. After that, federal states will have time to implement the law. The new pay system could be applied in 2026 at the earliest, Lauterbach said. “Until the reform really takes effect, many hospitals will go bankrupt.” Because of the federal government’s tight budget situation, he could not expect more resources that could prevent this.
This point was particularly important for countries. They pushed for additional funds in advance to financially support struggling institutions until reform. The document states that it would be verified whether “new measures to guarantee liquidity are also necessary with regard to the evolution of tariffs and inflation in hospitals outside the federal budget”. Another reason for the sometimes difficult financial situation is that many federal states have not met their investment commitments in recent years.
The president of the German Hospital Society (DKG), Gerald Gass, warned that there should be “uncontrolled hospital deaths”. This leads to waiting lists and supply bottlenecks. “In cases where hospitals are going to be eliminated or redesigned, politicians must take the population with them from the beginning and explain in a concrete and transparent way how health care will be guaranteed in the future”, demanded Gass.
Statutory health insurance companies, for their part, expressed concern that the quality specifications for the clinics could not be implemented. “In the end, there must be a reform that really promotes hospital care,” said AOK federal association president Carola Reimann of Handelsblatt.
>> Read here: Lauterbach must weaken clinic reform
“There is a risk of making too many compromises in terms of quality, which will be at the expense of patients.” From the point of view of the health insurance funds, the service groups are the central element of the reform. “However, they must be specified at the federal level — without lazy concessions at the expense of quality and patient safety.”
More: “Harmful reputation” for hospitals: Countries oppose Lauterbach’s reform