How to fix Germany’s ailing health system – DW – 06/01/2024

To hear Karl Lauterbach put it, it’s not revolutionary. Speaking at the annual doctors’ conference in early May, Germany’s health minister said the two-year reform plans marked a “Zeitenwende” (change of times) in care. of German health – a statement on the Chancellor’s military reform. Olaf Scholz announced after Russia’s full invasion of Ukraine in March 2022.

Another 15 different laws are in the “critical phase,” Lauterbach told medical experts, all of which are part of an effort to address the many challenges facing the country — including: Doctors who too few, too many empty hospital beds, too much financial pressure on hospitals, and too little digitization.

Opinion on his ambitions is divided: Doctors’ associations have praised Lauterbach’s ambitions, while health insurers have warned it could lead to higher premiums. As Dirk Heinrich, an otolaryngologist and chairman of the medical association Virchowbund, told DW, the changes are “light and shadow.”

Eugen Brysch, chairman of the patient protection association Deutsche Stiftung Patientenschutz, reached a difficult conclusion: “The Federal Minister of Health has many ideas. But there is no doubt whether they work,” he said. tell DW.

A new way to pay hospitals

One of Lauterbach’s biggest and most controversial projects was approved by Olaf Scholz’s Cabinet this week – the transformation of two hospitals that will change the way German hospitals are financed and set new standards of care.

Germany has the highest number of hospital beds per capita in the European Union (7.9 beds per 1,000 inhabitants – EU average: 5.3) but maintaining them is expensive. According to Lauterbach, this left many hospitals on the verge of bankruptcy. The result is that many patients are kept in hospitals unnecessarily so that the hospitals can charge health insurers more money – which causes a nationwide increase in health care costs and insurance premiums.

The change means hospitals will no longer be paid per treatment – instead, they will receive a guaranteed fee for making certain services available. It is hoped that this will reduce the financial pressure on hospitals to contribute as much as they can, even though they are not well suited to do so.

This change should ensure that patients who need complex treatment are referred to specialists early. This, according to the Ministry of Health, will reduce health costs over time, as patients have a better chance of being treated and are less likely to make mistakes. Lauterbach says this change will save tens of thousands of lives a year.

Too many hospitals

“The transformation of the hospital is right and important,” said Heinrich. “We have a lot of patient care, but what is happening now is very little. Changing hospitals without a complete change in outpatient treatment, and without changing emergency care will not do difference.”

Brysch was also skeptical. “In the field of outpatient medical care, the elderly, chronically ill and dependents will find it difficult to find a new doctor,” he said.

Germany is also struggling with a shortage of doctors’ offices in rural areas, as fewer doctors want to live there. The Ministry of Health wants to deal with this issue by giving rural clinics more money. Here again, Brysch was careful: “The fact that good opportunities to earn money are already being created will not lead to more doctors in rural areas. In fact, other factors of the area they also play a role.”

One issue has been resolved in the new updates: The cost of payments for general practitioners. Doctors have long complained about this budget – and sometimes gone on strike because of it – because they say it often forces them to treat patients for free. By lifting the cap, Lauterbach hopes it will give doctors an incentive to accept more patients. Heinrich welcomed the move, but again, said it failed to go far enough. “It stops in the middle, because the budgets are still there for special doctors,” he said. “It doesn’t help the patient if they can get an appointment quickly with their family doctor, but they have to wait months before seeing a doctor.”

Lots of small changes

Other small reform projects are less controversial: Lauterbach wants every patient to have a single digital medical record showing treatments and test results from all doctors which he saw.

There are also plans to reduce wait times at doctors’ offices by allowing doctors to conduct consultations online or over the phone, and to provide year-round prescriptions for people with chronic illnesses. Until now, such patients have had to return to the doctor every three months to have their prescriptions renewed.

The new Krankenhaus-Atlas (hospital atlas) is now online. It allows patients to compare hospitals using an overview of treatment options, case numbers and complication rates, as well as information about hospital staffing levels.

Edited by Rina Goldenberg

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