At Merkur.de, the opposition has harshly criticized Lauterbach’s current reform. There is a “hospital death like the Federal Republic has never seen before”.
Berlin – “It’s a revolution,” said Health Minister Karl Lauterbach when he presented his plans for hospital reform. Essentially: away from the case-by-case payment system and greater medical specialization. This means that not every hospital should offer everything. In the future, the smaller institutions in particular should limit themselves to those interventions that they are good at.
But a number of houses will also have to close and the supply in rural areas seems unclear. Union and Left forecast at Merkur.de hospital deaths, and associations are also sounding the alarm.
CSU criticizes Lauterbach’s quality standards
The federal and state governments had been struggling to find a compromise for months. The B countries, i.e. those under the leadership of the Union, have long resisted the proposed level allocation. Lauterbach has now adapted this evaluation scheme for hospitals and promised transparency. “You can imagine it like stars in a hotel rating,” explains CSU health politician Stephan Pilsinger to our editorial team.
However, the Munich member of the Bundestag criticizes: “I have my doubts as to what the quality parameters that have yet to be determined actually say about the services at the respective hospital.” What constitutes “quality” is “still completely unclear” in the key points. According to the key issues paper, one wants to NRW model of performance groups orientate. For this it says:
The federal and state governments jointly develop and are responsible for the definition and further development of the performance groups with quality criteria that are defined by a statutory ordinance that requires approval.
CSU resistance to Lauterbach reform: Holetschek veto to Karlsruhe?
When the federal-state consultations started, even more decision-making power was planned for the federal government. Now the co-determination of the countries is apparently to be increased. “The planning sovereignty must clearly remain with the federal states,” Pilsinger demands. “Otherwise we’ll only have legal battles and the reform would result in a deformation of the German hospital landscape that nobody wants to imagine.”
Bavaria, in particular, saw itself not being sufficiently involved for a long time – and was the only federal state to vote against the reform, Schleswig-Holstein abstained. Bavaria’s Health Minister Klaus Holetschek (CSU) complained that the effects on hospitals in rural areas were unclear. If there are no improvements from the point of view of the Free State, one even reserves the right to say no in the Bundesrat, “or to go to the Federal Constitutional Court”, as Holetschek said Munich Mercury said.
Criticism of hospital reform: “A heart attack must be treated immediately in the vicinity”
The cornerstones refer to “cross-sector providers” (so-called “Level II hospitals”). These include planned hospitals that are integrated into the care plan of the federal states, such as health centers or other outpatient-inpatient centers. “If you include these hospitals, I can see that comprehensive medical care is roughly guaranteed,” says Pilsinger. Complicated or plannable operations such as hip surgery could be carried out at larger locations. Pilsinger, who also works in a family doctor’s practice in the Munich district, is concerned about emergency care in rural areas: “A heart attack or a stomach bleed must be able to be treated immediately in a smaller clinic nearby, not 50 kilometers away.”
“Lauterbach initiates a hospital death, as it has not seen the Federal Republic”
Lauterbach promised that the reform would be a “guarantee of existence for small clinics in the countryside”. This also helps hospitals in East Germany in particular, because many hospitals there are at risk that no longer have enough treatment cases under the previous system.
Ates Gürpinar, spokesman for hospitals and care policy for the left, sees this as a deceptive maneuver: “Hospitals that are assigned to the planned Level 1i will be made into better care facilities,” predicts Gürpinar. “As acute hospitals, they are closed without the outpatient care structures being able to absorb this or even a corresponding expansion in the outpatient area being systematically planned.” Closures would be “reinterpreted as guarantees of existence”. Or to put it another way: “Lauterbach initiates hospital deaths that the Federal Republic has never seen before.”
The opposition also knows that there is a need for reform. Many hospitals are financially miserable. Even Lauterbach admitted on Monday that “many clinics are still going bankrupt” and that some will close until the reform takes effect. Gürpinar, once state spokesman for the Bavarian Left, therefore criticizes: “No revolution is being planned here, certainly not a left”. And further: “The failed case flat rates are kept alive. The ‘sacred cow’ that hospitals should make profits remains.”
In the future, 60 percent of the costs of clinics should be covered by provision flat rates, said Lauterbach. “That takes away the economic pressure.” Gürpinar sees this promise broken. “Lauterbach himself admits that in the next few years many hospitals will be brought to their knees by economic pressure. He is using the economic pressure of the current system to be able to push through his reform.” Accordingly, only clinics that meet the relevant quality criteria can receive the flat-rate payments. Everyone else will have to close.
“Even good hospitals will die”
The extent of the feared hospital closures is so far unclear. The head of the German Hospital Society, Gerals Gaß, said on ZDF: “We expect that every fourth or fifth hospital will not survive the next five to seven years.” Before the reform takes effect, “many small hospitals, especially in rural areas fall away.”
Michael Decker, head of the Diakonie Hospital in Freiburg, warned Mirror: “Lauterbach himself has established that the current financial pressure, to which he is not reacting, will also cause good hospitals to die.” The hospitals that do a lot of things that are badly paid are particularly affected. Obstetrics, for example, or paediatrics – “two poorly paid fields per se”.
Tino Sorge, health policy spokesman for the CDU/CSU parliamentary group, sees “only a minimal consensus”. He criticizes the period. Also due to the parliamentary summer break, a law should only be passed in the summer. It will probably be valid from January 1, 2024. “A reliable agreement will thus be postponed until autumn,” says Sorge. “Uncertainty will continue to prevail in the hospital landscape for as long as it takes.” Many questions remain unanswered before the reform is cast into a passed legal text. (as)
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