Bundesgesundheitsminister Prof. Karl Lauterbach zur Krankenhausreform

Summary

The speaker addresses the ongoing crisis in Germany's hospital sector, highlighting issues like over-provision, under-provision, and mis-provision of care, which lead to inefficiencies and poor patient outcomes. They advocate for a reform to improve quality and resource allocation by shifting from a volume-based funding system to a capacity-based one. The reform aims to enhance specialized care, support rural hospitals, and eliminate financial incentives that drive unnecessary procedures. Without this change, high-quality hospitals will face closures, particularly in underserved regions. The reform is positioned as a crucial step towards a more efficient and equitable healthcare system.

Takeaways

• 😀 The hospital sector in Germany is in crisis, with expensive healthcare costs, moderate quality, and under- and over-supply issues.
• 😀 Germany has the most expensive hospital care in Europe, but the quality of key treatments, such as cancer care, is often average.
• 😀 One-third of hospital beds in Germany remain empty, yet a third of hospitals operate at a loss.
• 😀 There is a mismatch of medical services, including under-supply in areas like pediatric care, stroke treatment, and childbirth, while some areas face over-supply, such as knee prostheses.
• 😀 There is a widespread agreement among medical professionals that healthcare reform is urgently needed to address the current crisis in hospital care.
• 😀 The reform proposal aims to eliminate the current over-supply, under-supply, and misallocation of healthcare resources.
• 😀 The reform will shift from fee-for-service models to a budget system based on fixed allocations, aiming to better distribute resources across regions and specialties.
• 😀 Cancer care must be specialized and of high quality, with all clinics providing treatments up to the standards that even doctors would trust for their own care.
• 😀 The reform intends to reduce unnecessary procedures, such as knee prostheses, which are sometimes treated as lucrative procedures instead of medically necessary ones.
• 😀 The reform introduces more stringent quality control measures, including requiring at least three specialists per medical service group to ensure high standards.
• 😀 Small rural hospitals will be supported through targeted funding and structural changes, allowing them to survive by focusing on simpler, local care while not performing complex procedures that they are not equipped for.
• 😀 Without the reform, Germany risks an unprecedented hospital closure crisis, which would disproportionately affect high-quality hospitals that cannot survive under the current financial model.

Q & A

What is the main issue facing the German hospital sector as discussed in the speech?

The main issue is the crisis within the German hospital sector, which is characterized by high costs, mediocre quality of care, particularly in cancer treatment, and the coexistence of under-, over-, and mis-provision of services.

Why is the current hospital care system considered unsustainable in Germany?

The system is unsustainable because it is the most expensive in Europe, yet it offers mediocre quality in many critical areas, such as cancer treatment. Additionally, a third of hospital beds are empty, and many hospitals operate at a loss, with a mismatch between healthcare supply and demand.

What does the speaker mean by 'underprovision' in the hospital sector?

Underprovision refers to areas where there is insufficient care, such as in children's services, stroke care, and obstetrics. For example, in some regions, stroke patients may have to wait up to 50 minutes before receiving care, which costs lives.

How does the speaker define 'mis-provision' in the context of the German healthcare system?

Mis-provision refers to unnecessary or poorly executed treatments. An example is the over-treatment of cancer cases in non-specialized clinics, where the quality of care is suboptimal. This often happens in hospitals that treat a small number of cases and lack specialized expertise.

What is meant by 'overprovision' and how is it problematic?

Overprovision refers to the overuse of certain medical procedures, such as knee replacements, where hospitals may perform surgeries that are not medically necessary for financial gain, treating patients as 'cash cows.' This is unethical and leads to unnecessary healthcare costs.

What is the proposed reform aiming to address in the hospital sector?

The reform aims to eliminate the problems of under-, over-, and mis-provision by shifting from case-based payments to capacity-based payments. This will allow for more control over resource allocation, improving service quality and ensuring that hospitals are not incentivized to perform unnecessary procedures for profit.

How does the reform propose to change hospital funding?

The reform will reduce the reliance on case-based payments, which reward hospitals for treating more patients, and instead introduce capacity-based payments. This approach will allocate 60% of the budget to hospitals based on the capacity to provide care, helping to address uneven service provision.

How will the reform help smaller hospitals, especially those in rural areas?

The reform provides subsidies for smaller hospitals in rural areas, ensuring their survival. It also introduces cost-covering contracts for basic care and allows them to focus on less complex procedures while not being required to perform highly specialized treatments that they cannot manage effectively.

What does the speaker suggest would happen if the reform is not passed?

If the reform is not passed, the speaker warns of an 'unprecedented hospital death,' where high-quality hospitals would close first due to insufficient reimbursement for quality care. This would lead to a breakdown of the healthcare system, particularly in rural areas.

What is the speaker's stance on the quality of healthcare post-reform?

The speaker emphasizes that the reform is focused on improving quality. There will be no compromise on quality standards, and the goal is to ensure that every hospital treating cancer, for example, is of high enough quality that even doctors would choose to be treated there themselves.