Health Minister Karl Lauterbach calls the reform plans of his government commission for the hospital sector a “revolution”. But so far the overthrow is only on paper. In order to set it in motion, the SPD politician urgently needs the federal states. And the two largest distanced themselves immediately after the announcement of the reform project.
Hospital planning is a state matter and must remain so, said North Rhine-Westphalian Health Minister Karl Josef Laumann. It is not acceptable to want to control them centrally from Berlin. “You cannot compare the hospital landscape in Mecklenburg-Western Pomerania with that in North Rhine-Westphalia,” said the CDU politician on Deutschlandfunk.
He also expressed doubts about the financial feasibility. It won’t work without additional funds, said Laumann. Because of wage increases alone, hospitals needed more and more money. Then there are medical advances.
Strong criticism from Bavaria
The criticism from Bavaria was even sharper. The project interferes “unreasonably with the hospital planning competence of the federal states,” said Health Minister Klaus Holetschek (CSU). “The government commission and with it Mr. Lauterbach are proposing a centrally controlled, quasi-planned economy and highly theoretical system that would very quickly lead to a massive concentration of inpatient care offers.”
And like Laumann, he too is annoyed by the government commission’s promise of a cost-neutral reform. “There is still no compensation in sight for the massive increase in material costs in the clinics,” complained Holetschek. Apparently, the federal minister intends to get the existing underfunding under control by “redistributing it at the expense of other important supply institutions”.
A Berlin bureaucracy monster is looming.
The Bavarian Health Minister Klaus Holetschek (CSU)
As reported, Lauterbach had announced that it would free the clinics from the ever-increasing economic pressure on patients and staff. In order to get out of the “hamster wheel” of a constant increase in quantity with medicine that can be provided as cheaply as possible, the clinics would have to be financed according to new criteria.
The previous remuneration, which was solely dependent on the case, must be abolished in part and supplemented by remuneration for the mere provision of services. For this it is necessary to categorize all hospitals into nationwide levels, from basic care to maximum care, with corresponding equipment standards.
Both health ministers described the planned changes to the case-based flat-rate system as correct. “We need more medicine and less economy again,” said Holetschek. However, the concept harbors “the enormous risk of devastating mismanagement and even the destruction of necessary supply structures via centralized specifications”.
The planned “introduction of 128 benefit groups, each with highly detailed structural specifications” threatens “a Berlin bureaucracy monster that will tie up enormous forces and cause considerable costs for everyone involved in supply and administration,” said the CSU politician. And that is then the opposite of what is needed: “namely less bureaucracy and more tailor-made structures, geared to local needs”.
Berlin’s Health Senator Ulrike Gote (Greens) supports Lauterbach’s plans. She told the Tagesspiegel: “I assume that the approaches presented by the Federal Minister of Health on Tuesday can be financed and implemented.” She welcomes the reform of the case-based flat-rate system. But she warns: “Hospital planning is a matter for the state, it has to stay that way.” She also warns that regional peculiarities should be taken into account.
Health insurance companies warn of “partial nationalization”
Similar sounding resistance comes from the health insurance companies. “If in the future a significant proportion of the cash expenditures for hospitals are distributed by the state, bypassing the joint self-government, this will be a partial nationalization of the health system,” warned the CEO of Techniker Krankenkasse (TK), Jens Baas.
And the chairman of the board of directors of the umbrella organization of company health insurance funds, Franz Knieps, called the reform concept “a bold and interesting model for reorganizing hospital financing”. It is regrettable, however, that the government commission is “further pushing the way towards the nationalization of the health care system and curtailing the scope for self-government”.
In order to reach the necessary consensus with the federal states, they should now “present suggestions and questions” to the federal government by the beginning of January. However, the German Association of Cities has already warned against taking too much time with the necessary reform.
“We need a rescue package that works quickly,” said General Manager Helmut Dedy of the German Press Agency. “Otherwise, in five years, many important hospitals will no longer exist.”
The Government Commission, on the other hand, had recommended introducing the new regulations only gradually and “in a generous transitional phase”, probably also with a view to the necessary persuasion work in the federal states. The experts estimate a period of five years for this.
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Source: Tagesspiegel
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