Since the beginning of the year, Karl Lauterbach (SPD) has been arguing with the federal states about his plans for hospital reform. In the Merkur interview, the Federal Minister of Health explains why he thinks it is the only right way.
Munich – Federal Health Minister Karl Lauterbach (SPD) is skeptical before the federal-state meeting on Thursday as to whether the envisaged agreement on the key points for hospital reform can succeed. “It’s not certain,” says Lauterbach in an interview with the Munich Mercury. “In any case, we don’t make any rotten compromises at the expense of quality.”
Mr. Lauterbach, are you the gravedigger of the small clinics in the country?
No, on the contrary. Without our hospital reform, the small clinics in the country would have far harder times ahead than with it. The planned provision flat rates keep hospitals alive that can only survive with their current patient occupancy because municipalities inject large sums of money every year. These clinics are systematically dying without reform.
But even with the reform, some hospitals will lose entire departments. Some say what’s left has little to do with a hospital.
That’s wrong. Operations are performed in these clinics, there are specialists, and inpatient and outpatient care is offered. There will be further training for young doctors. Basically everything you need in the country on site – apart from the treatment of major emergencies and interventions for which these clinics are not suitable in terms of quality.
What about obstetrics?
If a municipality says: We would also like to have a midwifery service here, then it can take the money and invest it. The reform is not opposed to that. And if the quality is right, the service provided is of course paid for. But for a long time we made the mistake of paying hospitals for treatments, even though we knew that the quality there wasn’t that good.
That almost sounds as if many of today’s hospitals are downright dangerous. Is the quality really that bad?
No, nobody says that either. But we have a lot of room for improvement, especially in the treatment of heart attacks, strokes and cancer patients. The same is true of some orthopedic surgeries. If we centralize these services in clinics that are good at it, the results will be better. Anyone who deals with the subject knows that. Doctors and nursing staff are not to be blamed if they often lack the economic conditions for cutting-edge medicine. The countries also want to improve quality. That’s why it should be like this now.
Clinic reform – that’s what it’s all about
Performance groups, levels, provision flat rates – the matter is complex in detail. The core of the reform is to divide the currently more than 1,700 German clinics into three remuneration groups: local hospitals for basic care, regional clinics and those that are of supra-regional importance. This is to reduce financial constraints. Behind this, however, is also the idea, which Lauterbach and many experts found correct, that concentrating on larger hospitals would enable better equipment, greater specialization and better patient care. Bavaria and other states also consider a reform to be necessary, but reject, among other things, too rigid specifications from Berlin and call for better financial resources for the clinics from the federal government.
Interview with Karl Lauterbach: “We don’t have to wait for procedures in Germany”
Even if the reform is not yet taking effect, you want to publish an overview of the quality of German hospitals from 2024. How do you want to measure that?
I would like to discuss the details with the countries first. What is certain is that we have enough data to be able to make reliable statements. At the end there will be a good overview. However, it will not be about evaluating a clinic as a whole, but only a specific service that it provides. If a patient needs a knee endoprosthesis, for example, he can find out who is doing it well.
Will patients have to wait longer in the future if procedures are performed in fewer homes?
We currently have almost no waiting times for procedures in Germany. If, in the future, the simple treatments take place in smaller clinics and the more difficult ones in specialized houses, this would not change. In addition, the follow-up treatment could possibly take place locally in the smaller clinics, which brings additional relief.
Karl Lauterbach
He was one of the most prominent winners of the pandemic: when Chancellor Olaf Scholz set up his cabinet in 2021, Karl Lauterbach was not considered by everyone in the SPD, but by many citizens as a logical choice for the post of Minister of Health. During Corona, the SPD politician explained the scientific background in detail in countless talk shows, interviews and also on Twitter. However, when he later urged caution again and again, not everyone was so convinced. Nevertheless, the man from Cologne, who was once even a member of the CDU and received a scholarship from the Konrad Adenauer Foundation, has a lot of basics for the office: the 60-year-old studied medicine and later became head of the Institute for Health Economics at the University of Cologne. In 2005, Professor Lauterbach became a member of the Bundestag.
Lauterbach: “I don’t see any risk at all”
Not everyone is so convinced of the positive effects. The German Hospital Society even hinted at a connection between your plans and the election of an AfD district administrator in Sonneberg, Thuringia, on Twitter.
This is a low point in lobbying that I do not want to comment on.
But it is true that the East German states in particular fear a threat to supply.
In order to counteract this, in addition to NRW, Baden-Württemberg and Hamburg, we also want to involve another eastern German state closely in the drafting of a specific draft law. I would like to make this proposal to the federal states on Thursday.
Despite several rounds of negotiations, there is still a lot of criticism from the countries. Bavaria isn’t the only one who fears that the federal government will exceed its powers if it intervenes too far in hospital planning. Could your reform ultimately fail before the constitutional court?
No. It is appropriate to examine such a major reform for its constitutionality. But I don’t see any risk at all. I can assure you that we know the constitution just as well as our colleagues from Bavaria.
An important step could also be the common cornerstones that you want to decide with the federal states on Thursday. Will you agree?
That’s not for sure. In any case, we don’t make any lazy compromises at the expense of quality. But reform will come in the end because it is needed. The countries know that too.
Interview: Sebastian Horsch
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