Let's hold on:
On December 6th, 2022, Federal Health Minister Lauterbach announced a „revolution“ and the „overcoming of the DRG-System" at the German Hospital Day, which took place in Düsseldorf as part of the Medica. Based on the proposals of a government commission, a uniform hospital planning, for nationwide uniform hospital levels was proposed. Service groups to become defined should then be relevant, on the one hand, for hospital planning and definition of services and, on the other hand, for a normatively to be determined reserve financing.
The German physician journal reported on Monday, May 8th, that the federal states oppose the introduction of uniform levels of care across the country. This element is central to hospital reform.
Our comment:
As we understand it, in the government commission's proposal, the individual elements are compellingly linked. Only through uniform hospital levels, defined by service groups, then does normative reserve financing make sense. If hospital levels are not defined in a uniform way, different services will be financed through the planned uniform holding remuneration. This cannot be desirable.
As a result, this is good information for our healthcare system and patients, because the proposals of Minister Lauterbach and the government commission would have led to a significant reduction in the availability of healthcare services. The free accessibility of healthcare services is a quality feature with which we in Germany have always had a certain advantage in international comparisons - e.g. compared to England. This would be threatened. A rationalization of health care services through the back door with long waiting lists and two classes of medicine - rural regions vs. urban centers - would be most likely.
Without the uniform hospital levels, we cannot imagine the linking of a holding remuneration and planned service groups. It is therefore clear that the reform will look different than previously planned.
That's a good thing, too, because our analysis and others show that linking the holding remuneration to the service groups designated for planning would lead to an exacerbation of current problems and is not likely to eliminate the "hamster wheel" effect and the economization of medical decisions.
Still, reform is necessary and will come. The proposals of the government commission contain very good targets and approaches, and we are sure that these will continue to be discussed.
In addition, we advocate a graduated and harmonious introduction of the various new planning and reimbursement tools. Together with the possibility of daycase inpatient treatments, sectoral reimbursement and ambulantisation, so many new elements are being introduced simultaneously without accompanying an appropriate controlling that target-oriented management will hardly be possible.
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