Thursday, December 28, 2023, 11:33 a.m
Towards the end of the year, the not unexpected snow chaos and brief blackout. However, health policy chaos and reform standstill all year round, regardless of the weather. Federal government – states – parties – bickering and blockade, instead of the reason-based culture of debate and discussion that is befitting a – still – leading industrial nation with a cultural background. With reduced consultation hours in practices, fewer available beds in clinics and maximum dissatisfaction from everyone as a logical consequence of a qualitative shortage of skilled workers in important decision-making bodies.
One would almost think that the planned revolution in healthcare has already run its course, because experience shows that only then do problems and shortages of care really begin, as is almost the norm at the moment. In 2023, not even the basic supply was and was spared from the prescribed downward trend. A banal cut injury is no longer treated on site and promptly as a matter of course, but can result in a similar odyssey through the district and its clinics, which has become common practice in urgent emergencies not only since today. In an emergency, valuable time that is crucial to life is lost, and in the rest of everyday care, any understanding of any further health policy-ideological experimentation is lost.
Controllable emergencies must not be allowed to be ultimately derailed by long hospital searches in a labyrinth of incompetence and ignorance about the specific capacities available. Medically necessary family doctor and specialist appointments must also be available in line with needs and in sufficient quantities, as must their performance-related and cost-covering remuneration. Ensuring this is the core task of a functional regulatory and health policy. And not to gloat and polemicize about the income and leisure behavior of doctors and doctors.
Not only for single people and especially older people, the lack of care that has become a reality is the worst possible socio-political case and an expression of a significantly worsened quality of life. The same has been true for what feels like an eternity for clinical discharge management, which is anything but exemplary, for which there are even G-BA guidelines (December 17, 2015). Similar to how meteorites tend to hit craters, release dates fall on Friday afternoons, garnished with patchy communication and an inpatient/outpatient sector boundary that still exists and is well guarded by lobbyists.
None of the respective negotiators inside or outside the self-administration trust the other about the treatment path and avoid the day of the repeatedly postponed agreement on joint sector-free patient care. Parallels to politics are not accidental, but rather unavoidable, as personal interfaces based on party or professional politics dominate events. According to their doctrine, everything that only makes sense and is useful in patient care should not grow together, according to their doctrine. And what to do with the many prejudices that secure our own existence. In the DKI study on outpatient surgery in hospitals, three non-medical people responsible made the bold claim that clinics have to provide follow-up care for patients who have undergone outpatient surgery in practices. The fact that this takes place in exceptional cases with millions of outpatient procedures and anesthesia is possible, as in the opposite case, but not in the spirit and understanding of the BAO and its members and certainly not the rule.
Instead of cheap DKI polemics, it would be more appropriate to have empty beds – the minister is talking about a third! – has long been available for short-term inpatient and outpatient treatment cases with extended follow-up care. Maximum care providers also urgently need peripheral partner clinics where they can transfer patients for further care after complex treatments and operations in order to regain free capacity for difficult treatment cases. This patient-oriented form of cooperation does not work because it is not desired – often by non-specialist decision makers. In this way, medical progress is repeatedly thwarted by regulatory regression, to the detriment of the patients affected, but also of the entire healthcare system. Unfortunately, this has so far been with considerable success.
The equal sectoral remuneration for the same outpatient surgical anesthesiological services with the same high professional quality standards, which the BAO has been calling for for almost 30 years, could have been a reality for just as long as the associated positive effects on the German healthcare system and its resources. After a tough struggle, the legal basis for this has been officially created for a year now with Section 115f in SGB V – and so far nothing has happened. If you ignore a last minute draft bill, which clearly lacks the necessary intellectual maturity, the necessary awareness of the problem and the honest effort to create fair and sustainable framework conditions, given the amount of time that has elapsed. Anyone who acts so politically negligently in the current tense situation has continued to make conscious failure a categorical diminutive of their health and social policy and is on the agenda of the traffic light coalition for 2024.
This probably has two years to go, or at best. The time to compensate for the damage caused and to avoid further damage is becoming increasingly scarce, so every day counts! And every day that is wasted idly, not just in discussion groups, amounts to a confession against patients and healthcare professionals. Crisis meetings loudly announced in the media cannot hide why this had to happen in the first place and who bears the main political responsibility for it, without wanting to admit it publicly.
Anyone who confuses the term empowerment, which is contained in the law and is associated with an advance of trust, with high-handedness that is resistant to advice has lost this trust and requires close control by Parliament and civil society. The majority’s declared goal will be for this unacceptable current situation, with its breaking points that violate the dignity and basic democratic rights of patients and health professionals, to change positively from the beginning of 2024 without any alternative.
Dr. Christian Deindl,
President of BAO eV