Are the regions right to oppose healthcare reform in Germany?
German market experts are telling HBI that regional governments are gumming up any chance of meaningful hospital reforms. Controversial health minister Karl Lauterbach has been locked in long discussions with them, with regional governments wanting to retain hospital planning rights and fearing election-losing hospital closures being imposed on them if they don’t.
But Germany is notoriously over-hospitalised and over-bedded. The obvious way to improve the sector is by closing some hospitals down. As HBI members can read elsewhere, there are warnings that 2024 may see 80 hospital insolvencies – double last year’s tally.
This is despite the fee-for-service model being “gamed” by some operators, seemingly evidenced by the high number of elective procedures compared to other countries, and several huge inflation and energy price packages bailing out the whole hospital sector last year. Many private operators see this as a case of too many cooks in the kitchen.
But what is the argument against this point of view? This week HBI spoke to the German Hospital Federation. Marius Korte, EU policy advisor at the organisation, argues the hospital landscape should be planned on a regional level. “The vision should not be to plan the hospital landscape in Berlin. There should be regional planning to see if maybe we should merge, or even close, hospitals, but that shouldn’t be central or else you might see the closure of rural hospitals which are less profitable but much more needed.”
Hospital mergers cost money, he argues – and how can the regions be expected to make these investments if the hospital reform is still unclear?
Korte also argues the re-classification of hospitals, which would essentially limit which hospitals could do what in a bid to prevent over-activity, is both too simplistic to work and more complicated than the alternatives.
He says: “I can understand the need to create more transparency for patients, but dividing hospitals into 1, 2 and 3 is a bit easy. There is already a quality report initiative which hospitals have to complete every year.
“There’s also a website you can check to see how many cases each hospital has done – those kinds of services should be boosted and made easier to understand. That would be a good first step and easier than creating a whole new classification into levels.”
There is also a funding issue. Currently, German hospitals only receive money when delivering care. To make matters worse the tariff is only adjusted based on the costs of the previous year, meaning hospitals are essentially always strapped for cash. The proposed reforms from Lauterbach may change this somewhat by offering a lump sum on top of the fee-for-service payments.
But this does not mean every hospital can stay open. Perhaps there is a case for keeping the rural hospitals running – just under one fourth of the German population is said to live in rural areas. However at least some, probably in cities, will surely have to close. Dortmund, with a paltry 0.7% of the country’s population, has 1.2% of its hospitals – and the German press is reporting the west of Germany is most at risk from hospital insolvencies. If regional politicians cannot make the hard decisions, they need to hand them over to someone who can.
We would welcome your thoughts on this story. Email your views to Joe Quiruga or call 0207 183 3779.
