Federal Minister of Health, Karl Lauterbach (SPD) / axentis.de, Georg Johannes Lopata
Berlin – A mediation process as part of the hospital reform must be avoided. Federal Health Minister Karl Lauterbach (SPD) said this today at the hospital summit of the German Hospital Association (DKG).
Politicians from outside the field are often involved in the mediation process, which is why the results of such processes are often more out of the field than if an agreement had been reached beforehand, Lauterbach said. The wishes of the federal states must therefore be taken into account in the parliamentary process, the minister announced today.
He is alluding to the dispute over hospital reform that has been going on for months. Some federal states have therefore had has already threatened to appeal to the mediation committeeto enforce their demands in the legislative process. Minister Lauterbach had hardly taken this into account until now.
There should be different rules for specialist clinics than those previously provided for in the draft Hospital Care Improvement Act (KHVVG). This means that in future they will no longer have to provide general performance groups and the corresponding staff and technical equipment, Lauterbach explained.
Furthermore, hospitals that care for children with disabilities should be excluded from the fixed subsidies provided. Appropriate Possibilities of a cost coverage principle for some clinics he had already put this into action last week.
Lauterbach emphasized today that these “wise and sensible” requests from the states will be heeded and incorporated into the KHVVG for the planned second and third readings in the Bundestag.
The possible date for convening the mediation committee would be November 22, explained DKG CEO Gerald Gaß. The Federal Council meets on this day after the possible second/third reading of the KHVVG on October 18.
But the law should not be left stalled in the Federal Council, Gaß said. “It should not come to this.” There was also criticism today from Brandenburg Health Minister Ursula Nonnemacher (Greens). She criticized the tight timetable and called it “completely unrealistic.”
Other implementation issues
Lauterbach also admitted that the reform could change elsewhere as well. There are difficulties in implementing “two or three performance groups,” Lauterbach said today. There are problems, for example, with the planned service groups for special geriatrics and special pediatric surgery.
If you notice that these performance groups are not working, you will leave them behind and instead approach the North Rhine-Westphalia performance group concept, says Lauterbach. The NRW concept envisages 60 somatic performance groups, excluding the two mentioned.
We are also continuing to work on an impact assessment of the hospital reform, Lauterbach explained. This tool should be available at the end of September. He refers to an analysis tool that members of the government’s hospital commission and representatives of the National Association of Statutory Health Insurance Funds are working on. The head of the government commission, Tom Bschor, saw the first results of the simulation model. German medical journal explained in April.
Gaß suggested further changes in the hospital reform. He called on the members of the Bundestag to improve the KHVVG accordingly. Above all, the planned reserve financing is a thorn in Gaß’s side.
“There is no reserve funding that is independent of the number of cases,” said Gaß, alluding to the KHVVG regulation that federal states must allocate planned case numbers to hospitals for service groups or the case numbers from the previous year apply to calculate and pay out reserve funding.
Assigning planned case numbers is difficult
BMG Parliamentary State Secretary Edgar Franke (SPD) highlighted this allocation of planned case numbers in this debate. According to Gaß, this was “well written”, but will never be put into practice. Because this would mean that if the planned case numbers for some hospitals were to increase, the numbers in other clinics would have to be reduced.
Franke also surprisingly admitted today: “There will be no de-economization.” Last year’s case numbers will already serve as a reference for the planned retention payments, according to Franke. Because you can’t de-economize completely.
Economics is not unethical in healthcare, on the contrary, the hospital reform should reduce the economic pressure on clinics; in doing so, he expressed himself differently from Lauterbach, who, like a mantra, had repeatedly promised de-economization in the hospital sector through the hospital reform planned in recent months.
Fixed surcharges for independent financing
More independent financing could mean an increase in surcharges for hospitals for emergency care, Gaß suggests. Hospitals could also receive fixed support in future with regard to training and further education in order to be able to better finance this area in the future, he said. There are many areas that can be supported without taking the number of cases into account, Gaß said.
If this is not done, there is a risk of waiting lists for drugs, Gaß said. Lauterbach dismissed those fears. “I am confident that we are very far from that,” he said. While there are significant delays in getting appointments, this does not affect the hospital sector, Lauterbach said.
“The planned reserve financing is not reserve financing, but rather a kind of fixed downstream levy,” criticized Ates Gürpinar, a member of the Bundestag from the Left group. He explained that the hospital reform could not be saved with amendments, but was going in the wrong direction.
First, hospitals need to be financially supported and then reformed, he suggested. “If we want the reform to take effect, we need something for the transition so that the reform can take effect.”
German medical journal printout
aerzteblatt.de
According to Tino Sorge, CDU member of the Bundestag and health policy spokesman for the EU parliamentary group, an impact assessment and a needs analysis of the hospital reform are still needed. Countries would also need to be given more opening clauses to allow exceptions to the service groups for certain clinics.
He also criticized the way BMG treated members of the Bundestag. Important information about planned legal regulations or possible impact analyses, such as the Grouper currently developing, should not only reach parliamentarians the evening before important votes in the Bundestag. But this has been the practice for a long time, he criticized.
Bundestag member and Green Party rapporteur for hospital policy Armin Grau defended the reform after the summit. It will strengthen quality, counteract false economic incentives and improve the security of clinics’ financial planning, Grau said.
Given that the economic situation of many hospitals is strained, hospital reform can no longer be postponed. “Without effective and timely hospital reform, many more hospitals would find themselves in existential economic difficulties and the result would be uncontrolled hospital deaths.”
However, he also announced that the law would be strengthened wherever necessary in order to reliably and comprehensively increase the quality and cost-effectiveness of hospitals in the interests of our country’s patients and staff.
“To this end, we will also take into account the assessments of experts and associations resulting from the practice in a public hearing at the Health Committee”. This hearing is scheduled for September 25. © cmk/aerzteblatt.de