The Minister of Health is planning a large-scale hospital reform.
(Photo: dpa)
Berlin The Monopolies Commission assumes that the precarious situation of clinics in rural areas will not improve as a result of the hospital reform by Health Minister Karl Lauterbach (SPD). “The goals of the reform could be missed without taking into account further criteria for the population structure,” says the paper, which will be presented on Monday and is exclusively available to the Handelsblatt in advance.
With the reform, Minister Lauterbach intends, among other things, to ensure basic medical care in regions where it is difficult to operate a clinic due to the low number of treatments. In addition to the current case fee, hospitals should also receive a provisional fee, which is intended to cover the costs of medical staff and equipment regardless of the number of patients.
So far, clinics have sometimes been forced to stay afloat financially with unnecessary operations. In 2023, an unprecedented wave of bankruptcies is imminent.
The Monopolies Commission also considers such a lump sum to be necessary, but sees a problem in the planned distribution of the funds. The hospital commission set up by Lauterbach proposes certain criteria for this. These include the number of residents in a region, demographic factors, the services offered and the market share of the hospitals located there.
However, these criteria are strongly dependent on the number of cases, is it[called “The more cases a hospital takes care of, the higher the reserve budget will be,” writes the panel. “The goal of securing the necessary needs, especially in regions with a low number of cases, is not achieved or is only achieved with difficulty,” it says.
>> Read more: Reform proposals are available – Lauterbach announces “a revolution” in the financing of hospitals
According to the plans of Lauterbach’s commission, clinics that are the only facility in a region should receive a minimum amount. However, it is not clear whether this budget should be higher than the security surcharge that hospitals already receive, warns the Monopolies Commission. “The proposal of the Hospital Commission therefore leaves open whether the proposed exemption can actually be redirected to the necessary capacities.”
German hospital society calls for other basic funding
The committee therefore proposes distributing the reserve budgets according to other criteria, which are based on “non-controllable population structure and cost characteristics”. The Monopolies Commission counts population density and regional differences in labor and operating costs.
In addition, where several hospitals are active, budgetary funds should be allocated in a competitive process. However, the committee advises against cooperation with clinics. “These would be associated with a reduction in quality competition and considerable antitrust concerns,” it says.
>> Read also: Comment – Germany has learned nothing from the corona pandemic
The German Hospital Society (DKG) also has a different basic financing system in mind. The CEO Gerald Gass told the Handelsblatt that the provision fee should consist of a fixed and a variable element.
For the fixed part, locations are to receive the emergency level surcharge that already exists today. The previous amounts are to be increased fourfold, which corresponds to additional costs of one billion euros. The variable part should depend on the type of treatment that hospitals offer. Services with high variable costs should receive less upfront funding than those with low variable costs.
“As a result, a reserve financing logic will emerge that reflects the actual reserve costs of the individual hospital locations much more appropriately than is the case in the government commission’s proposal,” said Gass.
More: Why Germany has far too many clinics – and the emergency rooms are still overcrowded