On December 6th, 2022, Federal Minister of Health Prof. Lauterbach announced a "revolution of the healthcare system" and the "overcoming of the DRGs" during the German Hospital Day, which took place in Düsseldorf as part of Medica. Sven Sauermann Co-Managing Director of Healthcare Heads commented on this as part of a client project: "The final key points paper serving as a blueprint for the bill is now available. This hospital reform has not become a revolution and it is to be feared that the planned measures will lead to unintended misdirected incentives. DRGs will continue to play an important role."
The introduction of service groups and the partly new orientation of hospital remuneration toward service budgets undoubtedly pose an immense challenge. Nevertheless, this does not change the fundamental structural underfunding of hospitals. The planned redistribution of around 40 percent of previous hospital revenues from DRG case lump sums via the retention budget to the service groups - an amount of around 30 billion euros - is extremely complex and could lead to new distortions in the funding of hospitals. The exact criteria for this redistribution must therefore be carefully defined.
This redistribution alone does not solve the problem of structural underfunding. Sven Sauermann disagrees with the idea that the reform will take economic pressure off hospitals. As long as investment funding from the states and treatment revenues are inadequate, the economic pressure will remain. The reduction in DRG reimbursement will make it more difficult to compensate for cost deficiencies by increasing the number of cases, while the shortage of specialists exacerbates the situation. This is particularly evident in the funding of medical technology assets, such as CTs, MRIs and other X-ray equipment, but also cardiac catheter workstations, robotic systems or Hybrid ORs, which are essential for modern healthcare but are not financed via the DRGs and will not be via the service groups, too.
The question is how many hospitals will still exist before the reform takes effect in 2026. Many hospitals are already complaining about the threat of insolvency. Above all, municipal providers will not be able to compensate for the deficits in the long term, which could affect other areas such as schools, kindergartens and daycare centers, sports facilities and others. Sven Sauermann emphasizes that a cold structural adjustment affects all hospitals, including the necessary ones. The current reform in combination with the current underfunding leads to the destruction of structures that are urgently needed for adaequate healthcare services in the future.
"The pandemic has shown very well how important adequate hospital capacities are to provide adequate care to the population."
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Author: Healthcare Heads GmbH
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