Berlin The working groups of the traffic light parties had around two weeks to work out their proposals for a coalition agreement for a possible government. In the area of health and care, a six-page paper was created that includes extensive reforms in the areas of care, hospital care and pharmacies.
The main negotiators are now dealing with the proposals. There is no agreement. The negotiators leave it open which proposals will make it into the coalition agreement planned for next week.
Either way, the demands indicate the health and care policy direction of a possible traffic light government. An overview of the most important points:
The SPD, Greens and FDP assume that care costs will only be able to be met in future with higher burdens on the contributors. The working group’s paper states that the contribution to long-term care insurance is “increasing moderately”. This means that the 40 percent limit for social security contributions should finally be a thing of the past, since premium increases are also foreseeable for health insurance companies.
Top jobs of the day
Find the best jobs now and
be notified by email.
The traffic light groups want to relieve the contributors by financing non-insurance benefits such as pension contributions for family carers or pandemic-related additional costs from tax revenues.
People in need of care should no longer have to contribute to the nursing training through their own contributions, but these should also be borne by the taxpayer. The treatment care in inpatient care is to be transferred to the statutory health insurance and balanced across the board.
This means that there will be stronger tax financing for care services. The care reform decided by the black-red coalition in June provides for an annual tax subsidy of one billion euros from 2022.
According to calculations by the National Association of Statutory Health Insurance (GKV), income from long-term care insurance of 52.62 billion euros will be compared to expenditure of 54.48 billion euros in the coming year. This results in a deficit of 1.86 billion euros, which, however, does not yet take corona expenditure into account.
It is unclear how a traffic light government wants to deal with its own shares. According to the black and red long-term care reform, people in need of care are relieved of an average of around 410 euros per month after more than 24 months of care and around 638 euros per month after more than 36 months of care.
The working group’s paper states: “We will monitor the current regulation on percentage subsidies for the own shares.” However, the sentence is still in square brackets, so there is still no agreement.
The traffic light parties also want to strengthen home care, for example by providing more time sovereignty for caregiving relatives and greater financial compensation for care-related professional downtime.
The traffic light groups also want to improve the situation of the relatives of those in need of care.
(Photo: Imago / Westend61)
The SPD, Greens and FDP also promise a legally secure solution for so-called 24-hour care, which is mostly carried out by women from Eastern Europe. The Federal Labor Court ruled that domestic helpers’ on-call time should be assessed and remunerated like working time, which makes 24-hour care unaffordable for many families.
The traffic light groups want to counteract the dramatic shortage of nursing staff with measures “which quickly and noticeably improve working conditions”. The aim is to accelerate the personnel assessment process in inpatient long-term care. When it comes to payment, geriatric care workers should catch up with their colleagues in nursing, where they earn significantly better.
However, the parties leave it open how this should work. Through the tax exemption from surcharges, the abolition of shared services, the nationwide payment of training allowances or more family-friendly working hours, the care profession should become more attractive overall.
Tax revenue also for statutory health insurance
In view of the dramatic financial situation of the statutory health insurance (SHI), reforms are actually inevitable for the traffic light parties. For the coming year alone, the managing federal government had to support the coffers with a record sum of 28.5 billion euros in order to keep the additional contributions for the insured at 1.3 percent – not even including the possibly increasing corona expenditure.
The traffic light apparently does not want to move away from this increasing tax financing in essence. “We are regularly dynamising the federal subsidy for statutory health insurance,” says the paper. At the same time, however, the cash registers should also be relieved, in particular through low drug prices.
To this end, the VAT rate on drugs is to be reduced to seven percent. The health insurers are hoping for an “effective immediate measure”, as the head of the Techniker Krankenkasse, Jens Baas, recently said in the Handelsblatt.
The lowering of the VAT rate is also one of the few measures that private and statutory health insurances are calling for. There is also support from the population. According to an as yet unpublished survey by the opinion research institute INSA on behalf of the Central Association of Private Health Insurance (PKV), which is available to the Handelsblatt, 79 percent are in favor of this measure.
In addition, the pricing procedure is to be further developed according to the drug market reorganization law (Anmog), in which health insurance companies and manufacturers negotiate the reimbursement amount for drugs. These should not only apply one year after entering the market, but after seven months.
In an initial statement, the National Association of Statutory Health Insurance Funds expressed itself cautiously optimistic. A spokesman for the Handelsblatt said that they wanted to wait for the coalition agreement to be completed. In the paper that has become known, however, “topics and tasks that are important both from the point of view of supply and from a financing point of view are addressed”.
More money and less burden on the nursing staff.
(Photo: imago images / Future Image)
Reform of outpatient and inpatient care
A central construction site of the traffic light parties is also the hospital supply and financing. There are almost 2,000 hospitals with almost 500,000 beds and a total of 1.3 million employees in Germany. The number of clinics has been falling for years as the number of treatments has also been falling.
The health insurance companies in particular are therefore pushing for the hospital landscape, which is perceived to be inefficient and too expensive, to be converted into specialized centers. The traffic light parties are now apparently planning a federal-state pact with the goal of “modern and needs-based” hospital care.
A government commission should present recommendations for this – for example for hospital planning based on criteria such as accessibility and demographic development. In the future, hospitals should also receive money depending on their level of care (primary, basic, standard, maximum care, university clinics) through a “differentiated system of revenue-independent flat-rate fees”. In addition, the federal government is to assume “a portion of the expenditure incurred for needs-based investment support for hospitals” in the federal states.
For better outpatient care in rural regions, the parties are striving to expand health and emergency centers. Among other things, they want to tackle the reform of emergency care that has not been implemented so far by – to put it simply – hospitals and statutory health insurance physicians work together more closely. “We are making it easier to set up municipal medical care centers and their branch practices and are reducing bureaucratic hurdles,” the paper says. The provision of medication in the emergency centers is also to be improved through “more flexible requirements in the pharmacy operating regulations”.
The digitization of the healthcare system is to be pushed further.
(Photo: dpa)
Cannabis “for consumption” is legalized
Legalization of the addictive substance cannabis was one of the points on which the three parties would probably be able to quickly agree from the start. The paper now says: “We are introducing the controlled supply of cannabis to adults for consumption purposes in licensed shops.” This could control the quality, prevent the transfer of contaminated substances and ensure the protection of minors, according to the three parties. The law is to be reviewed after four years.
Continuation of the digitization of the healthcare system
In this legislature, the healthcare system has become more digital than in the past decades combined. The electronic patient record (ePA) and the electronic prescription will be introduced step by step, the health insurances will reimburse the app on prescription and hospitals and health authorities will receive billions for digitization. There is great concern that the new government will lose the pace.
After all, the traffic light parties want to pursue a “regularly updated digitization strategy in healthcare and nursing”. Digital competence is to play a stronger role in training for health and care professions. In addition, the introduction of the EPR is to be “accelerated”. It is already available to all insured persons, but its functions are still severely limited.
In addition, a package to reduce bureaucracy is intended to lower hurdles in supply – for example, by checking the social security code for documentation requirements that are no longer up-to-date. Telemedical services are to be made possible “regularly”. These include the parties “medication, therapeutic and medical aids ordinances as well as video consultation hours, teleconsultations, telemonitoring and tele-emergency medical care”. Gematik, in which the federal government holds the majority of the shares, is to be expanded into a “digital health agency”.
More: Financial market, digital, pension, economy: This is the new state of the traffic light negotiations