;Resize=(1200,627)&impolicy=perceptual&quality=mediumHigh&hash=984e0a689e622af5210a3a6565b6cd673e7148d9b3e217a2426d6fe6ef254c58 "Hospital Reform: New plans bring five key changes to patients")
Before the federal and state governments seek a compromise for the hospital reform planned by the Ministry of Health in the federal-state meeting this Thursday, the ministry has drafted a revised key issues paper. The paper, which is available to FOCUS online, already includes the demands of the federal states. For patients, the draft brings five important changes:
1. Level facilitate the rough classification of the hospitals
So far Hospitals of different sizes and orientations exist side by side in a largely uniform manner: University hospitals, special hospitals and hospitals are therefore difficult to distinguish for patients at first glance.
Future the reform divides hospitals into three stages:
Level I hospitals as local contact points. In addition to inpatient services, Level II hospitals also provide outpatient specialist and general practitioner services. By combining specific service groups, Level II hospitals form the professionally comprehensive backbone of general care and emergency care. Specialized clinics complete the range of care. Level III hospitals offer the broadest and deepest spectrum for complex care needs.
The higher the level, the more treatments a hospital offers. University hospitals fall into level III. A higher level also means more funding. This makes it easier for patients to classify hospitals.
What is new in the revised key issues paper is above all, that the joint design continues to stick to levels. Countries and some hospital representatives criticize this idea from Health Minister Karl Lauterbach (SPD). As a compromise, the draft now notes that levels “have no legal obligation to ensure inpatient care by the federal states”.
2. Performance groups point the way to the right hospital
So far Many hospitals offer as many services as possible. This sometimes leads to unused capacities and prevents a concentration on hospitals that offer services of a particularly high quality.
Future the federal states divide hospitals into service groups. They decide which services a hospital offers. The service groups should distribute services more efficiently and bring patients to particularly qualified hospitals.
New is that the performance groups should be further developed with the participation of health professionals and several levels of government. NRW Health Minister Karl-Josef Laumann (CDU) developed 60 performance groups in a broad participation process, which the reform will probably largely adopt. Lauterbach recently spoke at a press conference of initially around 75 groups that the ministry had already assigned to the 1,719 hospitals. Patients are yet to find out what all this means in detail for their local clinic.
3. Better treatment thanks to quality criteria
So far hospitals receive their flat rates regardless of the quality of the treatment provided. Lauterbach complains that a lack of incentives for good treatment worsens care. “Germany has significant quality deficits when it comes to plannable and emergency interventions,” he said at a press conference by the Ministry of Health last week.
Future The Ministry of Health no longer pays for bad hospitals. For each service group, the federal government requires quality criteria that hospitals must comply with. If you don’t meet them, you don’t get any money and have to close. The budget released goes to the other hospitals that meet the quality standards.
A card should clearly show patients which clinic has which service group and whether it meets the quality criteria. So people in Germany find it easier to get good treatment. Countries and local politicians are under pressure to improve the quality of local hospitals. People shouldn’t be cared for in bad hospitals, says Lauterbach.
New is states that, in order to ensure inpatient care, the federal states may also assign hospitals to performance groups that “do not meet all the quality criteria” of the performance group. For patients, this means that not all hospitals will meet the quality criteria of their service groups in the future.
4. Longer distances due to quality criteria and performance groups
So far Even bad hospitals kept themselves alive because of the quality-independent financing. In addition, many hospitals offered as many treatments as possible. Patients therefore found treatment close to where they lived – albeit sometimes a bad one.
Future some bad hospitals are eliminated. Patients will then be treated better, but will probably have to drive further. The service groups may also mean that some hospitals are no longer allowed to offer treatments and that residents have to go to more distant hospitals for these treatments.
New is that federal states are allowed to keep the distances short: This is achieved by assigning service groups to hospitals that “do not meet all quality criteria”. In terms of security of supply, the draft leaves a back door for hospitals with poor quality. However, the transparent reference to these deficiencies by means of an overview map creates pressure for improvement.
5. Treatment with less time pressure
So far Doctors, nurses and patients complain about the financing of hospitals through flat rates per case: Facilities cover their costs by treating as many patients as possible, the financing model forces doctors to work at intervals with hectic treatments. Everyone involved suffers as a result.
Future According to the will of the Ministry of Health, hospitals cover a large part of their costs through so-called “reserve financing”: They receive this money regardless of the number of patients treated simply for offering the treatments, i.e. for keeping them available. In return, the case-based flat rates are reduced.
As a result, hospitals depend less on the total number of patients treated for their financing. Doctors can take more time with individual patients.
However, hospitals will not receive more money as a result of the change. Lower flat rates per case and advance financing should balance each other out – a criticism of many hospitals that, according to their own statements, are fighting for financial survival.
New is the calculation of the reserve budget. Areas such as paediatrics, obstetrics and emergency care should receive an “additional security surcharge” in order to reduce the pressure to treat there more. The countries had demanded that. Parents can rejoice.
It is also about details, such as adjusting the provisional financing if the number of cases changes, for example due to the closure of nearby hospitals. The federal states have until the end of 2025 to make the corresponding legal adjustments.
changes likely
The key issues paper for the federal-state discussion is likely to be further adjusted in the talks. Many passages in the draft also plan future adjustments based on initial experience. That should improve the bottom line. For patients, however, it also means that nothing is final yet. Keep calm and follow further developments.