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Berlin – Experts generally welcomed the planned emergency law and the associated reform of the emergency services with great unity. In today’s hearing in the Bundestag’s Health Committee, everyone involved emphasized the importance of appropriate reform of both areas in emergency care and effective patient management. However, there was also clear criticism in some areas.

Regarding the planned on-call service, which the associations of statutory health insurance physicians are supposed to organize around the clock, the chairman of the board of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen, made it clear: “We don’t have the staff for that.”

In response to repeated requests from MPs from the coalition factions, the CDU and the AfD, he made it clear that the population should not be given the signal that there would be additional positions for care in the future “if it takes too long in the practices.”

Rather, it must be clarified which treatment needs are required at which level and at what point in time, and this is binding nationwide and quality assured.

Markus Beier, co-chairman of the Association of General Practitioners, also emphasized that when discussing dual structures in care, it must be taken into account that this project would actually create a “multiple burden” since the doctors are on call alongside the KV on-call services , their practices now have to provide this additional service. “No general 24/7 offer is possible,” says Beier.

Psychiatric care should also be integrated into the planned Integrated Emergency Centers (INZ), which are to be set up at selected clinic locations nationwide, at least with the involvement of teleconsultation or connected specialists.

When people with mental illnesses or acute psychological symptoms went to an emergency room, they too often remained untreated or received incorrect care, emphasized the Federal Chamber of Psychotherapists. Since several questions have been asked by MPs on the topic, there could be corresponding expansions of the supply offer in the planned INZ.

When asked by MPs, the health insurance experts pointed out the possible cost savings if the reform was implemented accordingly.

Christian Karagiannidis from the University of Witten/Herdecke sees a “big lever of two billion euros” that can be saved through the emergency reform. “With the reform, we have to ensure that many people are cared for before they go to hospital,” he told the committee. There must be effective patient management so that as few patients as possible end up in the hospital.

Karagiannidis, who is a member of the government hospital commission, also called for emergency care in the KV system to be adjusted. Instead of a 24/7 on-call service – which is criticized by the KVs – a service “that visits patients at home in the next two to six hours” could also be sufficient. This must be made clear by law, said Karagiannidis.

For the INZ, he calls for uniform and structured requirements for quality and data transmission across the country. For good patient management, “uniform nationwide communication about opening times is important,” he emphasized. He also called for adequate financing of emergency rooms and emergency care, which the statutory health insurance associations provide.

Debate about INZ locations

The experts also discussed the question of which locations the INZ should be set up in the future. Some advocated for guidelines from the Federal Joint Committee (G-BA), others see the state committees as having a need for planning.

When it comes to the topic of emergency services, the survey of experts made it clear that the emergency services organizations and the professional associations of emergency physicians clearly welcome a reform. The Green Party’s health policy spokesman, Janosch Dahmen, asked all organizations and associations during his speaking time. Everyone agreed that this reform was needed for the emergency services.

In advance, there was clear criticism from the municipalities and the federal states, which wanted to be included in the reform considerations. They see no federal responsibility because the rescue service has so far been organized regionally. In response to questions from government and opposition parties, the air rescue associations also agreed that the reform was needed. However, associations such as the German District Association were not questioned in the hearing.

The federal government’s responsibility for the reform was also emphasized by two other experts who were invited by the traffic light factions and the Union: Andreas Pitz from Mannheim University of Applied Sciences emphasized that the federal government has legal competence to protect the population from harm. The state law on emergency services is too heterogeneous, so it is appropriate to regulate emergency medical care in social law.

The Björn Steiger Foundation, which has been campaigning for improved emergency legislation and care for years, also made something similar clear: Christof Chwojka, managing director of the foundation, announced that a constitutional complaint would be lodged against the state rescue service law in Baden-Württemberg and against the federal government There is no corresponding law at the federal level.

Part of the reform is also a quality committee for emergency services, which is to be located at the Federal Ministry of Health. Here the experts advocate expanding the committee to include several professional groups. So far, four representatives of the National Association of Statutory Health Insurance Funds and four representatives of the federal states are planned.

Patient representatives, emergency paramedics and other professional groups could also be involved here, it was said at the hearing. For the National Association of Statutory Health Insurance Funds, the committee is a good idea, “but the list of responsibilities is a bit extensive,” complained Wulf-Dietrich Leber from the National Association of Statutory Health Insurance Funds. Other experts emphasized that the relationship between the quality committee and the GKV BA needs to be clearly clarified.

Even from parts of the opposition, only cautious criticism of the draft laws was evident in the MPs’ questions: With their questions, the CDU MPs primarily want to represent the position of emergency paramedics through extended training with additional qualifications.

When asked by the Union, the air rescue associations emphasized that it is technically possible to fly in the evening and even in bad weather – but many state regulations and corresponding contracts do not currently provide for this.

The problem of transferring patients from a higher level of care to a lower level, so-called “downward transport”, was also addressed by the Union: Here, Jan-Thorsten Gräsner from the Institute for Rescue and Emergency Medicine at the University Hospital Schleswig-Holstein advocated that health insurance companies These transports should be paid for in the future in order to conserve the corresponding capacity in clinics at higher care levels after successful care.

Criticism of the project could be heard from the questions from the members of the Die Linke group and from the BSW group: Matthias Schrappe, who was invited as an individual expert by the BSW, is generally critical of the fact that there should be control of patients. “From my 20 years of experience, patients cannot be controlled,” says Schrappe. © bee/aerzteblatt.de