The German health minister, Prof. Lauterbach, announced a "revolution" for the German healthcare system" today, 06.12.2022. He presented the key points for the new hospital financing together with the spokespersons of the government commission "hospital care" (Ms. Gürkan, Prof. Bschorr, Prof. Karagiannidis).
The new hospital financing is based on the three pillars:
1. introduction of uniform national hospital levels (I - III)
2. introduction of 128 service groups
3. financing of maintenance costs as general service based on numbers 1 and 2.
Hospital level
Level I (care close to the patient's homes)
- corresponds to today's primary care
- is subdivided into i and n
- i = integrated out-patient/in-patient care
- n = emergency care in the ER
- " Removal from the DRG system"
- Financing via daily flat rates instead of case lump sums
- Beds can be allocated by out-patient physicians
- Nursing staff can take over the management of the department and
- Employment of physicians is possible.
- The aim is to create an incentive for intersectoral integration of care.
Level II (regional)
- Corresponds to today's standard and specialized care
Level III (transregional)
- corresponds to maximum care
Service groups
- The government commission recommends to introduce 128 service groups. Structural requirements will ensure uniform quality of medical care throughout Germany.
- Services are to be provided only in hospitals for which certain service groups have been defined.
Maintenance costs
- 40% retention costs were proposed for the defined service groups in level II and III hospitals, and 60% for the departments of neonatology, maternity care, intensive care and emergency medicine.
- The contingency costs finance the operating costs of hospitals in combination with the case lump sums, which are significantly reduced, and the nursing budget (approx. 20%).
- This is meant to be budget neutral.
- A recommendation is made to set up an additional structural fund solely for pediatric and adolescent medicine, through which these service groups can receive 20% more budget.
- This means that the operating costs of Level II and III hospitals will be financed by 20% nursing budget, 40-60% maintenance budget and 20-40% DRG case lump sums.
The self-government is now given the task of implementing these specifications. The Health Ministry will soon discuss the proposed model with the parliamentary groups and the government of the Federal States. The government commission will continue its work and, above all, submit proposals on the quality of processes and results and on investment financing.
Professor Lauterbach expects long-term cost increases, as investment financing has not yet been resolved and baby boomers will increasingly become patients. In return, medicine is improving.
We are looking forward to the changes and are at your disposal for conversations about this topic.
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