An initial draft bill for hospital reform could be available at the beginning of next year at the earliest – this is the result of the most recent meeting between the federal and state governments on 23 November. In the opinion of the BDPK, the consensus required for an agreement between the federal and state governments could be achieved with the planning instrument it has proposed for integrated regional care.
When presenting their key issues paper in July, the federal and state governments announced that an initial draft bill for hospital reform would be on the table by September. However, the negotiators are clearly still a long way from this at the end of November. The still fundamentally controversial points were to be discussed again on 23 November at a meeting between Federal Health Minister Karl Lauterbach and the federal states, after which a consensus draft was to be presented. However, the meeting was cancelled after a short time.
Separate construction sites
The BDPK believes that the planned financing system is based on the illusion that the existing problems will be solved if clinics are closed and money and staff are redistributed. This fallacy will cause the reform to fail and lead to even greater problems, as it is to be expected that established care structures will be destroyed that could not be rebuilt, or only slowly and at great expense. In order to overcome the central problems in a viable and sustainable manner, the existing construction sites of our healthcare system must be clearly separated from one another.
The biggest issue is the structural underfunding that has existed for years. The resulting difficult economic situation of hospitals has been drastically exacerbated by energy price increases, inflation-related additional costs and higher labour costs. There is only one solution to this – irrespective of possible medium or long-term reforms for the other construction sites – and that is to adjust hospital remuneration as quickly as possible so that cost increases are fully and promptly taken into account. To this end, the state base rates and psychiatry fees would have to be adjusted in line with inflation. Only then will it make sense to initiate far-sighted and courageous measures for structural improvements and a modernisation of the financing system or to combat excessive bureaucratisation and the shortage of specialists. However, if the underfunding is not eliminated, insolvencies will make further reforms superfluous.
Seeing care areas as a whole
The BDPK believes that a practicable and effective way to reach a common denominator in the reform is to introduce a planning instrument that is focussed on the relevant care services in the regions. The reform proposals to date have focussed primarily on the planning of hospital care. However, if outpatient, rehabilitative and nursing care, as well as emergency services, are ignored, no real progress for patients is possible. It makes more sense if the care areas are considered as a whole and in their interaction. Otherwise, there is a risk of care deficits, especially in rural regions.
The BDPK had proposed to the negotiators for the reform that the federal and state governments jointly develop such a planning instrument. Based on a regionally determined supply requirement, this could be used to identify underuse and overuse and make corresponding planning decisions. Where general practitioner and specialist care is not guaranteed, clinics would have to be consistently opened up to outpatient care by contract doctors. With such positive incentives, good healthcare provision would be achieved in the regions and the reform would find a way out of the impasse.
Article published on the BDPK website
