Hospital.Help

Berlin The announcement by Federal Health Minister Karl Lauterbach (SPD) that there will be a few hundred fewer hospitals in this country in ten years was sharply criticized by the first chairwoman of the Marburg Federation, Susanne Johna. If the minister assumes there will be 300 or 400 clinics, then we are roughly talking about one in four general hospitals that will close, she said yesterday at the 144th general meeting of the Marburg Federation.

This is dangerous in many ways. It is to be feared that the gap between health care in urban and rural areas will widen, says Johna. The closures are likely to affect small hospitals in particular. Functioning medical services must not depend on where you live, but must be guaranteed everywhere in Germany, demanded Johna.

In addition, the closure of hospitals always means resignations from doctors, nursing staff and other professional groups. This would involve negotiations and the financing of a social plan, and it would also cost a lot of money to dismantle structures. Johna doubted that the money from the planned transformation fund would be sufficient for this.

This is intended to support restructuring as part of the hospital reform in the period from 2026 to 2035 with up to 50 billion euros. In a motion passed, the delegates at the general meeting called on all those involved in the healthcare system to ensure that no patient care specialists are lost in the transformation process as part of the hospital reform.

Johna emphasized that it would also be extremely negligent to reduce capacity without taking sufficient reserve capacity into account for disaster situations. It seems as if the pandemic has already been forgotten, it seems as if people are suppressing the fact that cyber attacks are increasing, and much worse, that Putin’s war of aggression against Ukraine continues to lead to several 100 injuries and deaths per day, warned Johna. These points would not be taken into account in the hospital reform. But you can’t just gear the supply to the population based on snowy weather conditions.

Instead, you have to prepare for disaster scenarios and at the same time do everything to ensure that the corresponding plans never have to be taken out of the drawer. Nobody should be able to say that the need for reserve capacity could not have been foreseen, said Johna.

Hardly any planning security for clinics

With regard to hospital reform, she would have hoped that the government would decide on a fundamental reform of hospital financing that would give clinics more planning security and take economic pressure off of care. Unfortunately, the results now available hardly do justice to this claim.

Nevertheless, shortly before the hospital reform was passed in the Bundestag, some positive changes were introduced, above all the plan to introduce the medical personnel assessment instrument of the Federal Medical Association (BK). “This is a huge success,” she said, drawing applause from the delegates.

The consequence of the introduction of PS-BK would also be that colleagues in further training would be recorded numerically for the first time, says Johna. That didn’t matter before. Johna also welcomed the planned financing of further training. To this end, the general meeting called on the legislature by motion to give the Marburg Federation and the Federal Medical Association, as representatives of doctors, equal rights to the central association of statutory health insurance (GKV), the association of private health insurance (PKV) and the Germans when it comes to structuring the financing of further training Hospital Society (DKG) to participate.

Reorganize reserve financing

In addition to these positive aspects that the hospital reform provides, the provision of funding based on the number of cases still needs to be criticized, says Johna. The delegates also passed a motion calling on the legislature to correct this. The application states that the reserve financing must be more closely oriented towards supply needs. The complexity of the combination of old-style flat rates and new flat rates based on the number of cases will not mean that hospitals in the area that need them are adequately financed.

However, a retention fee should finance the necessary structures for the provision of services, in particular patient-related staffing. The MB is therefore committed to completely revising the planned regulations and developing a system that is independent of the number of cases. Another proposal on this topic suggests calculating the financing of the maintenance costs based on energy costs, water, wastewater, disposal, insurance, building management and personnel costs. These cost groups are the same in all clinics.

Johna further criticized Minister Lauterbach for badmouthing the quality of hospital care. If you badmouth something long enough, you not only demotivate your employees, but also create distrust among the population, she warned. The fact that Lauterbach justifies the hospital reform with the poorer life expectancy in Germany compared to other European countries is also incorrect.

It is doubtful whether people in Germany will live healthier lives on average because we will soon have fewer hospitals available, said Johna. Instead, a stronger focus on prevention is needed. She called on Lauterbach to invest more in primary prevention, i.e. in exercise, healthy nutrition in schools and health education. Every euro that we don’t invest there now will result in huge costs in the end.

Present the bureaucracy relief law now

She also criticized the fact that Lauterbach had announced a significant reduction in bureaucracy in supply at the MB’s general meeting last year and that nothing had happened yet. She doesn’t understand why, because Lauterbach would be breaking open doors with his cabinet colleague and Federal Finance Minister Christian Lindner (FDP) by reducing bureaucracy. A law that reduces bureaucracy and doesn’t even require financial resources – that must be the dream of every finance minister, especially if he is also the FDP chairman, emphasized Johna.

De-bureaucratization doesn’t cost money, but it does require courage and assertiveness towards those responsible for funding and possibly also within your own ministry. The delegates at the general meeting called on the minister to submit the long-announced draft law to reduce bureaucracy in the healthcare system.

The general meeting also dealt with the design of further training. The Marburger Bund called for legal support and legal protection for further training associations in order to continue to guarantee specialist qualifications to the necessary extent. Against the background of hospital reform, concentrated clinic locations and cross-sector care facilities, doctors will have to move to several different training centers in the future in order to be able to obtain all training content.

More outpatient procedures in further training

Furthermore, barriers between outpatient and inpatient care for further training must be reduced more. Outpatient procedures, wherever they are carried out, should be fully available for further training, can be carried out by doctors who are undergoing further training and should also be billable, according to another motion at the general meeting. This requires appropriate social law changes.

With regard to the emergency reform, the MB also called on the statutory health insurance associations to fully comply with their mandate to ensure outpatient emergency care or to show transparently where this is no longer possible. A gradual takeover of outpatient emergency care must be rejected, it says in an application.

According to another approved application, those hospital locations that have an emergency room in accordance with the tier classification of the Federal Joint Committee (G-BA) or are legally obliged to provide emergency treatment and are therefore still available to provide care should provide the services provided in outpatient emergency care in the same way as locations of integrated emergency centers (INZ). © cmk/aerzteblatt.de