Terrible false start to hospital reform.
Because of all the Corona, war and climate, it went almost unnoticed that Health Minister Karl Lauterbach presented a “Government Commission for Modern and Needs-based Hospital Care” on May 2nd. With their help, he wants to “tackle the biggest hospital reform of the past 20 years from 2023.” There was immediate anger about the composition of this commission, because among its 16 members there is not a single nurse to be found, not a single senior doctor, not a senior doctor and not a single assistant doctor, not a single health insurance company is represented, but professors of economics, public law or health sciences, spiced up with a few chief physicians.
To everyone’s surprise, at the beginning of July, after just two months, this commission made its first statement, namely recommendations for better financing of paediatrics, pediatric surgery and obstetrics. Why so quickly and why these three subjects first? Because it’s burning brightly there!
The insanity of hospital financing based on the severity of the diagnosis, the so-called DRG system, has led to catastrophic underfunding of pediatrics and pediatric surgery over the past 20 years. These subjects are low-revenue and are often only managed by the hospital authorities as a deficient appendage. Within pediatrics, higher-yield subdisciplines such as oncology or neonatology are just barely surviving, while much-needed general pediatrics is being slashed everywhere. A number of children’s hospitals have been downsized or closed entirely. Overall, the number of beds in the country fell by a third, while the number of cases continued to rise. It’s not about the health of the children, it’s about the health of the balance sheets.
Exactly the same fatal game has happened and is happening with delivery rooms and maternity wards. Thirteen delivery rooms were closed in 2018, nineteen in 2019, seven in 2020 and eleven in 2021 – making a total of 50 in four years! This did not happen because they were no longer needed, but because the DRG system was underfunded and the hospital was no longer able to cope. For this reason, despite the increasing number of births, the last hour has come for a third of all maternity wards in the last 15 years. The consequences are catastrophic. More and more births in fewer and fewer delivery rooms at ever greater distances from home mean that negative birth experiences are becoming the norm, and complications are increasing.
That is why the government commission first dealt with these three subjects. However, the initial joy quickly evaporated. Instead of a future-oriented big hit, the commission recommends only a few supplements to these DRGs and additional reimbursement volumes, which become smaller and smaller the larger the clinic is, while uncritically retaining the destructive DRG system. All the professional associations concerned predict that the problems that already exist will worsen. This is a veritable false start for this “biggest hospital reform of the past 20 years”.
A hospital reform can only succeed if there are well thought-out plans for the distribution of small, medium-sized and large hospitals as well as university hospitals for all regions of our country. It can only succeed if a flat-rate financing concept is set up according to the tasks and size of a hospital, free from diagnosis-driven false incentives. It can only succeed if non-profit is the sole form of organization, regardless of whether it is private, public or church-run houses. Then the listed hospital groups will be gone just as quickly as they appeared. Medicine could become possible again.
dr medical Bernd Hontschik is a surgeon and publicist: www.medizinHuman.de His book “Heile und rule! – A health policy tragedy, Westend Verlag. PHOTO: UTE SCHENDEL
