Berlin Actually, the press conference by Federal Health Minister Karl Lauterbach and his country colleagues should send a signal of unity. The SPD politician spoke of a “breakthrough” in his controversial clinic reform. Next to him were the health ministers from Baden-Württemberg, North Rhine-Westphalia and Hamburg.
A few hundred meters further, at the same time, Bavaria’s Health Minister Klaus Holetschek (CSU) stepped in front of the cameras and made it clear that there would be no agreement anytime soon. The talks were surprisingly constructive, he said – and qualified: “But we cannot agree to the reform in its current form.”
What the countries actually agreed on Thursday and what they still have to negotiate in detail was not entirely clear even after the press conferences. “The basic structure of the reform is in place,” said Lauterbach. Agree on 90 percent of the questions. “I am convinced that we will be able to present final key points before the summer break,” said the minister.
In essence, Lauterbach negotiated with the federal states above all about planned classifications of the individual clinics – from basic care close to home to a second level with other offers up to maximum care providers such as university clinics. These steps, also called levels, are obviously the sticking point of the negotiations.
Although they should no longer be a criterion for the financing of the clinics, which the federal government had already made considerable concessions to the states. There was great concern that clinics would be cut off from funds that are needed in rural areas, for example. However, the levels should continue to ensure greater transparency – the federal government applies them, but they have no consequences for the institutions. This is apparently still going too far in federal states like Bavaria.
According to the reform, the clinics should instead receive money for nationwide service groups. These are criteria that clinics have to meet in order to be able to bill the statutory health insurance (GKV) for certain operations, such as staff and medical equipment.
More than 1700 clinics affected
Stefanie Stoff-Ahnis, board member at the National Association of Statutory Health Insurance Funds, still sees this as an improvement on the status quo, “from which the patients benefit,” she said on Thursday. Because health insurance companies would only have to finance treatments in houses that meet the corresponding uniform criteria. 1,719 clinics across Germany are affected by the reform.
In the run-up, the federal government had therefore raised expectations of an agreement. There were even fresh key points from the ministry for the meeting on Thursday, which are available to the Handelsblatt and contain further concessions to the federal states. There it is assured in several places that hospital planning remains the task of the federal states.
It is also made clear that the nationwide performance groups are drawn up together with the states and that they must agree to them. In addition, there should be exceptions for the countries in the assignment of service groups to the houses. This primarily means facilities in rural regions whose closure is to be prevented. There is great concern that the reform could be softened to accommodate countries.
But apparently that wasn’t enough. The fact that no agreement was reached is a source of criticism, especially from the clinics. “The results give reason to fear that many hospitals that are needed will no longer experience the reform,” said the chairwoman of the German Hospital Society, Henriette Neumeyer, on Thursday. “They will go bankrupt even before that if they fail to provide political assistance.”
Inflation and the aftermath of the corona pandemic would continue to weigh heavily on hospitals economically. “In addition, there are the expected and necessary high wage agreements and uncertainties about the upcoming major hospital reform,” she said. “Unfortunately, the federal and state governments have again failed to agree on an interim law that could give the clinics economic security.”
Union praises Lauterbach timidly
From the Union, however, there were optimistic tones. “Just in time, Minister Lauterbach took the perspective of the federal states to heart,” said the Union’s health policy spokesman, Tino Sorge (CDU), the Handelsblatt. It was urgently necessary to include the expertise and preliminary work of the federal states in the reform process.
“Today’s deliberations give reason for confidence, because a basic framework is in place,” he said. “It will be crucial to specify this together with the federal states.” The planning sovereignty of the federal states must remain guaranteed.
Originally it was also planned to present a modeling of the consequences of the plans at the meeting. For the reform, the Federal Ministry of Health is having the whole of Germany evaluated for the first time, which clinics are so dilapidated that they are not allowed to offer operations according to the new quality criteria. Due to contradictory data, only part of the analysis has now been presented. The Ministry hopes to use the data to create a model from which each patient can read what quality can be expected in clinics for each treatment offered.
Financing still unclear
The financing of the reform remains completely unclear. Experts estimate the costs to be in the mid-double-digit billions. The cornerstones contain the indication that the federal states are responsible for hospital investments.
The federal states, which should actually finance the investments of the clinics in buildings and large medical technology, have not sufficiently fulfilled their obligations for a long time. How Lauterbach wants to change that is so far unclear.
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