/picture alliance, epics, Jeff Moore
Berlin – The federal states and the German Hospital Association (DKG) are pushing for more time for consultations and preparations for the planned hospital reform. In addition, in their opinion, there should be more options in the law for state-specific issues.
At the summer reception, the DKG initially invited the chairwoman of this year’s Conference of Health Ministers (GMK), Kerstin von der Decken (CDU), to give a keynote speech. But Federal Health Minister Karl Lauterbach (SPD) also wanted to speak to hospital representatives and other people from the health policy scene in Berlin.
Anyone who has a similar exchange of blows as last week at the National Association of Statutory Health Insurance Funds What he had expected was disappointing: things were peaceful between the three speakers – DKG board chairman Gerald Gaß also defended his demands on the law.
Everyone seemed to be trying not to block paths to compromise in the coming weeks of parliamentary discussion and negotiations and to once again emphasize their own proposals in the debate.
According to reports, Minister Lauterbach himself was included in the list of speakers on the morning of the event: In a short speech, he reported on numerous discussions on the reform and many requests for review from the parliamentary groups, which are now being processed by the Ministry. There is also direct exchange with the GMK and some countries on the content of the reform.
“Reform is urgently needed. By 2030, a quarter of hospitals would cease to exist if reform were not carried out,” Lauterbach emphasized again. From his point of view, the principles of the reform are also indisputable.
“We have to move away from the approach of 100 percent flat rates per case. The system of flat rates and performance groups has proven itself and is already being implemented to some extent,” he said, referring to the preparatory work in North Rhine-Westphalia. “It is very well done, it is going in the right direction.”
The minister tried to allay concerns about the preservation of small hospitals in rural areas, which have been repeatedly expressed by federal states and hospital companies. “The reform we are planning will make rural areas safer. We will provide surcharges for emergency care, intensive care, traumatology, stroke care, obstetrics and pediatric and adolescent medicine,” Lauterbach emphasized. Further safety surcharges are also planned. “We will do everything we can to protect the small homes that we need in the countryside.”
This also includes keeping an eye on the financial situation of the households. With next year’s reform, the state base case values will be recalculated. “This gives the households breathing space.” In addition, the planned transformation fund could come into effect as early as next year.
“These are prospects. When I talk to representatives, doctors and hospital managers, many tell me that the reform must come so that there is finally safety and reliability,” said Lauterbach. This planning will be possible from the autumn onwards – then the so-called grouping will be ready, with which the first effects of the reform can be calculated.
From Lauterbach’s point of view, conflicts surrounding reform are important for the success of projects: “This is a reform that was born out of conflict. This is necessary for all major reforms. A reform where there is no conflict does not solve a major problem.”
He was pleased that people were treating each other constructively in the discussions. “If we sometimes get 16 to zero votes from the states for our proposals versus what we are planning, then that is noble and gives us material for discussion and reflection,” Lauterbach emphasized. “It is a sign of a functioning democracy. That you discuss the issue, but do not degrade yourself personally and become irrelevant.”
GMK chairwoman von der Decken, the actual guest speaker of the evening, also advocated a focused exchange that should be free of party boundaries. She emphasized that as a state deputy she could have spoken in the Bundestag debate on the Hospital Care Improvement Act (KVVG) last week – but that would only have been possible during the speaking time of the CDU/CSU parliamentary group.
“I asked if it wouldn’t be possible for each party to give me one minute of speaking time, but that’s obviously not possible for formal reasons. “I would have to talk about a party ticket and I didn’t want that,” von der Decken reported.
She wants to avoid the country’s criticism of the law being linked to party politics. Despite their four different party affiliations, the 16 health ministers of the federal states have one line: “We all agree on the demands that we have repeatedly put forward in discussions over the past year and a half.”
Disappointment that the federal government has not yet incorporated the states’ demands into the current legal text remains high. “It would have made things much easier if our joint demands had already been included in the draft,” she said.
Now they want to talk to the parliamentary groups “through various channels”. In addition to the central demands of the states – interim funding, impact analysis, their own scope of action, a retention rate independent of the number of cases and the maintenance of the minimum quantity requirements of the G-BA – von der Decken also made two central requests.
“I ask that states and hospitals be trustworthy in designing care. Hospitals are willing to make changes. But they need instruments that allow them to work flexibly,” von der Decken emphasizes. “The second request: please do not rush anything. I expressly ask that you wait for the impact analysis before passing the law.”
In his opinion, countries need more time to assess the impact on their countries. This cannot happen within two weeks, as soon as the so-called grouper is available at the Federal Ministry in September. “Please do not rush anything. In an emergency, it would be better to discuss the legal text for another two or three months,” says von der Decken. “We carry out an environmental impact assessment in advance for every major construction project. And with the largest hospital renovation in history, don’t we want to do an impact assessment in advance?”
When it came to trust and time, DGK CEO Gerald Gaß agreed. “You spoke from the heart, we also ask for trust. Because those who take care of people deserve it,” said Gaß.
He stressed that the economic situation of hospitals must be clarified quickly. Financial resources must be made available from a transformation fund “so that we have the strength to achieve the transformation,” said Gaß. We must now find lines of compromise. From the DKG’s point of view, hospital planning in North Rhine-Westphalia is an example that all states could follow.
“We should start with NRW-pur for the reform and see from 2027 whether further adjustments need to be made at the beginning of the reform. There should be no minimum number of cases or restrictions on cooperation between hospitals.” The reserve funding also needs to be filled with life – there still needs to be time for development here. This too should only be addressed in a – possible – second phase of the reforms.
To give hospitals the strength to transform themselves and not overburden them with bureaucracy, swift action is now needed. This includes a swift end to minimum nursing staffing thresholds, an extension of the OPS structural examinations and no further tightening of bureaucracy, as stipulated in the Transparency Act and as planned in the Medical Research Act. © bee/aerzteblatt.de