Comments by Thomas Bublitz, Chief Executive of the German Federation of Private Hospitals (BDPK)
There is no doubt that we need hospital reform, the analysis is clear: finances (investment and operating cost financing) are lagging behind the cost trend, inflationary burdens are not balanced, bureaucracy is getting out of hand, there is a shortage of skilled staff and the many conservative structural requirements for hospitals are real innovation killers. According to surveys by the German Hospital Institute, 80 per cent of German hospitals expect a significant annual deficit for 2023.
Two core problems remain in the KHVVG draft, which went out to consultation at the end of September: It is envisaged that the federal states may only allocate the service groups after fulfilment of the federal requirements for the service groups at federal level. The Medical Service confirms their fulfilment every two years. Deviations by the federal states are only possible in consultation with the health insurance funds and otherwise in the event of excessively long journey times at federal state level. This means that there is effectively no more room for manoeuvre for hospital planning at state level. In my view, the federal states cannot afford to be disempowered in this way. Why not a little more restraint at federal level for the planning sovereignty of the federal states? A standardised national service group system for planning with the KHVVG would also be a huge success.
With its reference to the number of cases, the reserve flat rate is a complete regulatory failure. This will lead to new disincentives and the risk of waiting list medicine. Instead, it would be wiser to finance hospital units that are necessary but run at a loss (e.g. emergency departments, intensive care units or obstetric units) regardless of their utilisation and to offset them against the service revenues generated. This would ensure the provision of essential care.
The Hospital Care Improvement Act (KHVVG) passed by the Bundestag in mid-October will not improve inpatient care in Germany. The Bundesrat now has the last chance to do so. The BDPK is making concrete proposals for sensible corrections to the KHVVG.
The version of the KHVVG passed by the Bundestag on 17 October 2024 contained only isolated corrections compared to the previous draft. The main demands of the federal states and hospitals were still not taken into account. The law could only be amended if the Bundesrat decides to call on the Mediation Committee at its meeting on 22 November. Here are the BDPK’s assessments and demands:
- Provide sufficient funding
- Adapt the flat rate funding
- Maintain high level of planning by the federal states
- Secure specialised clinical care
The KHVVG must stipulate that hospitals receive inflation compensation when the KHVVG comes into force in order to stabilise the hospital landscape.
The survival of necessary clinics with low case numbers should be ensured by linking the maintenance payment with the provision of necessary but currently loss-making treatment services. In other words: full financing of operating and investment costs for either essential service groups (e.g. emergency department, emergency outpatient department/ICU, obstetrics department, intensive care unit) or hospitals in rural regions (in line with the system of the guarantee supplement). The minimum reserve figures should be removed from the law.
In order to ensure that the federal states can guarantee needs-based care for the population in hospital planning, the KHVVG must stipulate that the decision of the planning authorities remains the basis for the financing of services by the health insurance funds. The quality specifications of the service groups may therefore only have the character of recommendations for the planning authorities.
That the federal states can continue to decide on the allocation of ‘Level F – specialised clinic’ as part of hospital planning. The wording in Section 135d SGB V should be of a recommendatory nature and the federal states should be free to make their own decisions.
Read the full article on the BDPK website
