Jochen A. Werner is Chairman of the Board of the University Hospital Essen.
(Photo: dpa, University Hospital Essen)
Overloaded emergency rooms, admission freezes in children’s hospitals, a lack of medication, not enough general practitioners and now also a lack of blood supplies – what actually still works in our healthcare system?
A lot of people have asked themselves that in the past few weeks. I would like to give the all-clear and say that the current infection situation, the high level of sick leave among employees and an unfortunate chain of circumstances in general are the triggers for the mood of disaster.
But that would only be half the truth. Rather, we should finally stop talking up the repeated crisis scenarios as a temporary ailment of the health system. They are no coincidence, but symptoms of a profound structural crisis in our healthcare system and society.
What are the reasons for the undesirable developments? The number of deficiencies is too extensive and the implications too profound for a full analysis to be made here.
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I will therefore limit myself to the two most important factors: the impact of demographic change on health care, which has been completely underestimated up to now, and the digitization offensive that has been missing for decades.
Health care funding is spiraling out of control
The nursing shortage, which in truth has long been a shortage of skilled workers across all professional groups, is becoming a limiting factor in health care in Germany. As society ages, not only are more and more people retiring with their expertise.
These people also reappear in the healthcare system – but not as nurses or doctors, but as sick people or people in need of care. The increasing imbalance between service providers and service recipients will push the healthcare system to its limits.
And not only in medical terms, but also in financial terms, because the financing of health care is spiraling out of control. In 2022, the federal subsidy to the health fund was already almost 30 billion euros. This is almost twice as much as in 2019. These ultimately debt-financed expenditures are plastering over structural problems in the healthcare system that would otherwise affect the insured in the form of higher health insurance contributions.
Because of the demographics that cannot be changed, the second system failure hurts all the more, namely the still fallow digitization. It could be a central solution, a real game changer.
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Instead, for years we have only seen stagnation in connection with grotesque failures, such as the widespread uselessness of the electronic patient file (EHR); the downright bizarre cessation of the e-prescription pilot over privacy concerns; the still missing use of an electronic identity or the implementation of the hospital future law, which is agonizing over time.
The profound deficits in the healthcare system are based on past omissions and cannot be solved in the short or medium term. They can only be managed in the best possible way. And above all, quickly: every day of hesitation exacerbates the problems.
Lauterbach’s hospital reform falls short in many ways, but it is a start
The hospital reform initiated by Federal Health Minister Lauterbach is by no means a revolution and falls short in many respects. Above all, it avoids the fact that we have an overcapacity of hospital beds and clinics in Germany. Around 30 percent of the clinics could be closed, repurposed or merged without the quality of medical care suffering as a result.
The specification of content and time targets is also missing. Nevertheless: Lauterbach’s reform is based on an accurate analysis, contains sensible approaches and, above all, is the first reform impulse that should be taken seriously in what felt like an eternity.
In one fell swoop, it will neither break the vicious cycle of the healthcare system nor the dominance of particular interests or the associated lack of willingness to change and the braking federalism. But the hospital reform can and must be the starting signal for a fundamental modernization of the healthcare system, the first step in what is unfortunately still a long journey.
In this respect, 2023, the year in which the second half of the legislature period begins, will be the year of the irreversible fundamental decision on the question of whether the healthcare system will be able to ensure its efficiency and affordability.
Or whether we remain incapable of acting here and at some point look back in amazement at the ruins of a system that once worked, such as the railways, the German armed forces, the transport infrastructure and, basically, education.
The author:
Jochen A. Werner is Chairman of the Board of the University Hospital Essen.
More: “Hospitals are in an emergency” – hospital reform should be in place by the summer