D.he role of hospitals in the pandemic is far from clear. Great praise is mixed with criticism. But the discussion is already flaring up about what the hospital system should look like in the future. Nobody denies that the houses have proven to be resilient in the fight against Covid-19 and have prevented worse: because of the good bedding in normal and intensive care units, because of the cancellation of postponed operations, but also because the system of general practitioners is the same as other countries did not know, the hospitals have had their backs. About 10 percent of all German Covid cases came to hospitals and of these about 20 percent came to intensive care units.
In a message of greeting for the second hospital summit of the German Hospital Association DKG, Chancellor Angela Merkel (CDU) thanked the doctors and nurses in the clinics for their commitment during the crisis. The employees worked at their limits for months. In the meantime, the third wave of corona has broken, and more and more houses can return to regular operations. The virus has not disappeared, said Merkel, but there is a great relief that one does not have to concentrate solely on dealing with the crisis.
The cost of coping has recently been the subject of criticism. Both the Federal Audit Office and the statutory health insurance had complained that the whereabouts of subsidized intensive care beds was not clear and that there were many question marks to be asked about the free premium for corona-reserved beds. The clinic association rejected that. There is no evidence of any financial trickery, said DKG chairman Gerald Gass, not even on the part of the Court of Auditors. Regarding the additional intensive care places, he said: “These beds exist, but not all of them have been used. That’s a good thing.”
But if it had been necessary, it could have been operated. The federal states had also not found any manipulation with flat-rate fees. Such is not worthwhile anyway, since the accounts are checked and too much money paid has to be repaid through the year-round compensation.
Health Minister Jens Spahn (CDU) jumped at the clinics at the same event. Nobody can say now how the year 2020 went for the clinics: “I am now warning against rush-shot conclusions.” Gaß and Spahn want to use the pandemic as an opportunity to think about the future hospital structure. The minister said that the exceptional year may have shown as a kind of “experiment” that not all of the planned operations were necessary.
The health insurance companies had previously made it clear that there would never be as many clinic treatments as in 2019. “I don’t want this as a savings debate, but a quality debate,” assured Spahn. It is important to him that emergency and basic care is provided everywhere in Germany. That clinics should coordinate with each other and with outpatient providers and that some hospitals should specialize.
The corona pandemic has shown how well clinics and resident doctors can work together across existing borders. “Not every hospital has to do everything,” says Spahn. In the future hospital landscape, expertise must be expanded and used without neglecting rural regions. Adequate staffing is central to this. There are now personnel assessment procedures. However, nurses and those interested in the profession still lack confidence in reliability in the coming years.
The hospital structural reform is a “mega-task” for the twenties. “At hospitals, we don’t have any needs-based structures. We have oversupply, especially in the metropolitan area, we also have some undersupply. ”It is necessary to bring the supply together, that could also be done in the countryside. In terms of patient safety, however, it cannot be justified that some hospitals only perform difficult interventions eight times a year. “I am sure that a patient is ready to drive 20 kilometers further for a complex, predictable operation if he knows that his chances of survival will then increase by 50 percent.”
Hospital association chief Gaß added that outpatient and inpatient care should complement each other. “Since it is becoming more and more difficult to provide care through resident doctors in sparsely populated regions, the hospitals are ideal contact points here.” Even today, the clinics care for as many outpatients as inpatients.