BILD: Mr. Lauterbach, Germany has 1719 clinics. They want to downgrade almost 700 of them to level “1i” – without an emergency room, only with on-call service at night. After your hospital reform, how many of the full hospitals will still be real hospitals?
Federal Health Minister Prof. Karl Lauterbach: That depends on how we design the hospital reform and how the state governments then deal with it. I assume that many small clinics will be saved by the reform. In any case, the message spread by BILD, according to which up to half of the clinics in some federal states should “go away” is not correct. We want to keep the clinics that are necessary.
Even FDP health expert Ullmann, a friend of the reform, says about the “Level 1i” houses: “…that would no longer be the clinics we know today.” The head of the association of private clinics says their denials are “wrong and misleading: it’s no longer a hospital.” Are they all too stupid to understand your reform?
Some private clinic operators are against the reform because we are attacking the business model of the clinics, which make profits from unnecessary interventions, or perform interventions that should actually be done in larger clinics. That’s why they work with false reports, the citizens should be unsettled and get the message that the Lauterbach reform is destroying the local clinic. The opposite is the case.
But what kind of clinics are these that are no longer even allowed to be approached by ambulances and where there is no doctor on site at night?
These are clinics that can fix broken arms, but not acute heart attacks. This distinction is also in the interest of the patients. Or, if you have a stroke, do you want to come to a clinic that is not optimally equipped for it? We need a reasonable distribution of tasks. Patients should be cared for where it is best and makes the most sense. And in the case of difficult interventions, these are the houses in which they have a higher chance of survival.
do you have numbers
If a clinic is not optimally prepared, every third stroke patient has little chance of survival in the first year. In a qualified clinic, it is only every fourth patient. That’s thousands of people every year. Who among us seriously wants to be taken to the nearest clinic with a stroke instead of to a house with a stroke unit, a specialized stroke department? The layman thinks five minutes is all that matters. But if I’m in the wrong clinic and the clot can’t be dissolved, then the risk of serious health consequences – from dementia to death – is much higher.
From the clinic side, there is massive criticism of your reform from all areas – including municipal clinics…
That’s wrong. Municipal clinics also want the reform. The municipalities too. The criticism depends on the clinic. That I am attacking the profit model of private clinic operators is undisputed, yes. We want to partly de-economize the system, i.e. remove the profit incentive.
What does your reform mean for larger interventions – here too there is criticism from the hospital side?
With our reform, the probability of reaching an interventional cardiology and surviving a heart attack increases. Even more important: With cancer treatments, the probability of survival is significantly increased – the cancer society assumes 10,000 fewer cancer deaths per year if the treatment is only carried out in specialized clinics. At the moment we have some results that are not easily presentable internationally.
Sounds like the little clinics are messing around…
This is now a defamatory exaggeration – the doctors there do a fantastic job when it comes to the care of older people who have a minor medical problem – weakness attacks, broken bones, dehydration, gallstones… They are sometimes even done better there.
Neither the doctor nor his family go to such small clinics when, for example, a major cancer operation is pending. They naturally look for larger, specialized houses. But: I don’t want two-class medicine! Because let’s be honest: Many of the small clinics are currently only surviving because they treat those who are not aware of the differences in quality.
So the stupid go to the small clinics, the smart to the specialists?
A person without much information or without connections does not have to be stupid. The system is stupid. And the distinction “small clinic – large clinic” does not help either. One thing is certain: anyone who knows what they’re doing is already avoiding certain clinics, looking for and often getting good care. As a result of the reform, we must come to the point where the interventions are only carried out where the doctors would also be able to treat themselves. It cannot be that major rectal surgery is done in clinics that cannot do it. It is unacceptable for strokes to be treated in hospitals that do not have a stroke unit. It can’t be that we do simple gallstone operations in expensive university hospitals. It can’t be that we have so many clinics – but in the end not enough nurses for all houses. None of this is correct.
The German Association of Towns and Municipalities demands: The classic emergency care must remain secured for every citizen close to home. Can you agree?
Yes. After our first analysis of the current situation, we have almost 600 clinics nationwide at level 2 and above. This means that we have a high density of emergency care across the board. That’s a clinic for 100,000 adult residents, that’s more than enough.
The clinics make a loss of 9 billion euros per quarter, banks have classified clinics as a risk industry, clinics are already dying across Germany…
Lauterbach: “We are actually at the beginning of an uncontrolled death in hospitals. Without the reform, 25 percent of hospitals would probably die. We want to prevent that and ensure that the necessary clinics can survive – in individual cases with a slimmed down but needs-based range of services. There’s no point in pouring more and more money into a sick system and a bad structure.”
What is bad?
We have the highest bed density per capita and, with Austria, the highest costs for hospitals in the EU – we spend 3.4 percent of our economic output on a system that doesn’t work. We have very high costs with sometimes poor or mediocre results. We don’t even have enough staff to maintain the old, inefficient structure. We need class instead of mass – nationwide. Hospitals must also be allowed to provide more outpatient services. Far too much is being treated in hospital.
Can you promise that the quality and accessibility of hospital care will not deteriorate for any citizen in Germany?
I can promise that the quality of care will improve significantly on average. If we don’t manage to do that, then we as the federal government don’t do this reform, then it’s dead.