/image alliance, Philipp von Ditfurth
Berlin The impartial chairman of the Federal Joint Committee warns of a deterioration in quality in the inpatient area due to hospital reform (G-BA) Josef Hecken. He is concerned that the reform could replace G-BA’s quality specifications with the help of legal regulations.
The result: we will have to deal with a large-scale reduction in quality, Hecken said today at a G-BA legal symposium. G-BA still has the minimum quantity instrument, the only instrument to guarantee the quality of supply. However, states may soon deviate from planned exceptions for performance groups, Hecken warned.
In the future, states may have a say in defining quality in hospital care through planned legal regulations that require approval. However, the sovereignty of hospital planning finds its limits where quality is not achieved, Hecken said. According to him, the 65 planned service groups contained only rudimentary specifications for the quality of service.
Hecken further criticized the fact that hospital reform was stated in public reports that it would increase quality and advance evidence-based medicine. However, the Hospital Care Improvement Act (KHVVG) is more of a quality reduction law and a state strengthening law.
Dagmar Felix spoke about G-BA being removed from power by KHVVG. It can be seen that the powers of the G-BA are increasingly being taken away, said the professor of public law at the University of Hamburg, who is also a member of the government hospital commission. The climate between politicians and G-BA is worse than ever.
Until now, the G-BA has been responsible for defining quality criteria for German hospitals. One would expect G-BA to also be a key player in this area as part of hospital reform, Félix said. But this is not the case. In the future, the minimum structural quality requirements in hospitals will be defined by the Federal Ministry of Health (BMG) are determined within the scope of legal regulation.
BMG must be advised by a committee formed by representatives of the National Association of Statutory Health Insurance FundsO German Hospital AssociationO Federal Medical Association, university medicine and nursing professions. The parallels with G-BA are more than clear, said Felix. This restricts the directive authority of the G-BA.
G-BA may continue to implement quality assurance measures, but must ensure that there is no contradiction with BMG requirements. This leads to unnecessary double structures, criticized Félix.
Hospital reform is leading to an increasing nationalization of quality assurance in the hospital sector. It is not yet known whether BMG will be able to reach the same level as G-BA, says Felix.
Criticisms of the clinical atlas and the healthy heart law
Hecken also criticized the Federal Hospital Atlas, which does not offer the transparency that Lauterbach promised. Citizens still have the impression that this is helping them, Hecken said.
He also criticized that planned healthy heart law, which Lauterbach wants to advance. The fact that the federal government wants to directly intervene in care with a new exam for young people and the increase in the prescription of statins for prevention is state medicine. This can be done, but Hecken thinks it is worth considering that this should now be done with the consent of the federal states. From his point of view, the main problem is that the law wants to introduce evidence-free medicines. This is a threat to patient care.
Hecken has for years criticized Federal Health Minister Karl Lauterbach (SPD) for ensuring that care decisions are not made by just one person who read a study. Lauterbach is currently pushing the law forward despite headwinds from the medical profession and self-administration.
German medical magazine print
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The public law professor at Martin Luther University Halle-Wittenberg, Winfried Kluth, also cited advantages if self-government deals with quality instruments. In this way, complex processes would be established with smooth generation of knowledge. Self-administration relies on the expertise and participation of various actors in the health system, Kluth emphasized.
This is a different quality from ad hoc ministry hearings, Kluth said. However, the former judge admitted that the often long duration of the G-BA’s decision-making procedures should also be taken into account. Overall, the costs of poor standard setting are higher than the costs of good standard setting, says Kluth. © cmk/fos/aerzteblatt.de