DGerman emergency care is itself considered an emergency. It suffers from a lack of personnel, a lack of competence, inconsistent quality requirements, financial disincentives and unnecessary deployments. Emergency services report that a third of their trips are minor cases. There is real abuse in that the ambulances are used as free taxis to get from the outskirts into the city. The supposed patients then got off at a suitable location, reports a person responsible. These incidents would usually not be reported and tracked due to the high effort involved.
However, most minor cases arise because sick people cannot get doctor’s appointments and therefore consult the emergency services “out of frustration and desperation”. The reasons are often language barriers and ignorance: very few citizens know the telephone number of the statutory health insurance on-call service, 116117, which is why they called the emergency number.
The division of labor is actually clear: in life-threatening cases, the emergency services at 112 are responsible. 116117, on the other hand, is used outside of consultation hours for illnesses for which you would normally go to a practice but whose treatment cannot wait until the next day.
The federal and state governments
Politicians have been trying to reform the emergency service for years. Most recently, Health Minister Jens Spahn (CDU) failed, but now his successor Karl Lauterbach (SPD) has taken on the issue. The reorganization, for which his government commission has made proposals, is complicated because the Association of Statutory Health Insurance Physicians (KV), the Federal Joint Committee and thus ultimately Berlin are responsible for the outpatient emergency service.
However, patient transport and emergency care in clinics are the responsibility of the federal states. The rescue service as a benefit is not even anchored as an independent norm in Book V of the Social Security Code, which Lauterbach wants to change.
The health insurance companies are now reporting improvements to his commission’s proposals. These are aimed in particular at the planned Integrated Emergency Centers (INZ), which are intended to coordinate outpatient and inpatient care. The core element of the INZ is an initial assessment center, which is to be operated jointly by the responsible clinic and the local association of statutory health insurance physicians. This so-called counter evaluates the centrally received cases using a computer based on uniform criteria and assigns the treatment to the right place depending on the severity: either the emergency room of the hospital or a KV emergency service practice.
According to the government commission, 450 such integrated emergency centers are needed in Germany. According to new calculations by the umbrella association of statutory health insurance (GKV), this is far from enough: “That would mean that 12 million people or 15 percent of the population would have to drive longer than 30 minutes to reach the nearest INZ,” said Stefanie Stoff-Ahnis, board member of the National Association of Statutory Health Insurance Funds, told the FAZ: “In order to provide needs-based emergency care, we will need around 730 integrated emergency centers across Germany in the future.” That would be 62 percent more than previously planned.
“Significant overcapacity” in the cities
The association essentially welcomes the reform approaches: in the future, milder cases would go to the emergency room, serious cases to the clinical emergency room. The counter serves as a central contact point for patients and as an interface between outpatient and inpatient care. As correct as the Commission’s proposals are, they fall short. Because they plan to set up INZ in all clinics that have a “comprehensive” or an “extended emergency level”.
However, the lowest category of the “basic emergency levels” may only be included in individual cases and according to unclear criteria. This three-part division follows the specifications of the Federal Joint Committee (GBA) depending on the clinics’ personnel and technical equipment.
For better adjustment, the umbrella association has created a new paper entitled “Needs-based planning and equipment of integrated emergency centers”, which is available to the FAZ. In it he criticizes that the concentration on the two highest emergency levels could lead to “significant overcapacity” in the cities on the one hand and to undersupply in the countryside on the other.
General definitions depending on the level are misleading; the actual supply needs should rather be determined. “It is crucial to have better distribution in rural areas so that an integrated emergency center is within easy reach of everyone,” says Stoff-Ahnis. “At the same time, the oversupply in metropolitan areas must be addressed, if only to employ only the skilled workers who are really needed.”
Based on 730 INZ, 550 emergency services that already exist in the clinics should be used; 180 would be necessary in addition. In addition, more of these practices would also have to open during the day, i.e. during normal office hours.
The umbrella association also calls for nationwide criteria: minimum standards for personnel and technical equipment as well as the opening times of emergency practices. Since these are subject to the security mandate of the statutory health insurance physicians, the GBA is responsible, which does not interfere with the state sovereignty over clinic planning. In addition to the National Association of Statutory Health Insurance Physicians and the German Hospital Association, the GBA also includes the health insurance companies themselves.
The new simulation from the GKV Association provides for a maximum of two doctors in the basic emergency level and up to five in the other levels for emergency practices. A round-the-clock operation in 1,000 clinics is “not economically viable”: the deployment of up to 7,000 doctors is completely unrealistic given the staff shortage.
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