To hear Karl Lauterbach say it, it's nothing short of a revolution. Speaking at the annual doctors' conference in early May, the German health minister said the reform plan, which he's been working on for two years, marks a “turning point in the era” for German healthcare, alluding to the military reforms Chancellor Olaf Scholz announced after Russia's full-scale invasion of Ukraine in February 2022.
Lauterbach told health experts that around 15 bills were at a “critical stage” – all part of an effort to tackle many of the problems facing the country, including a shortage of doctors, an excess of empty hospital beds, financial pressure on hospitals and low digitalisation standards.
Lauterbach's ambitions have been met with mixed reviews: Doctors' associations have praised his intentions, but health insurers have warned that it could lead to higher premiums. Dirk Heinrich, an ear, nose and throat specialist and president of the Virchow Bund doctors' association, told DW that the reforms are “light and dark.”
Eugen Brisch, president of the patient protection group German Patient Protection Foundation, came to a more bleak conclusion: “The federal health minister has many ideas, but I doubt whether they can be implemented,” he told DW.
Health Minister Karl Lauterbach launches major healthcare reform. Photo: Chris Emil Janssen/Imago Images
A new way to pay hospitals
One of Lauterbach's biggest and most controversial plans was approved by Prime Minister Olaf Scholz's cabinet this week: a two-pronged hospital reform that will change the way German hospitals are funded and impose new care standards.
Germany has the most hospital beds per 1,000 people in the European Union (7.9, compared with an EU average of 5.3), but maintaining them is expensive, which Lauterbach says has pushed many hospitals to the brink of bankruptcy. As a result, many patients are admitted unnecessarily, allowing hospitals to charge extra fees to health insurers, and thus raising healthcare and insurance costs across the country.
Under the reforms, hospitals will no longer be paid per procedure, but instead guaranteed income for providing specific services, which is expected to ease financial pressure on hospitals to cram in as many surgeries and procedures as possible, even if they are not fully qualified to perform them.
The reform will ensure that patients needing complex treatment are referred to specialists earlier. According to the Ministry of Health, this will reduce healthcare costs in the long run, as patients have a higher chance of being cured and are less likely to fall victim to errors. Lauterbach claims that the reform will save tens of thousands of lives a year.
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There are too many hospitals
“Hospital reform is right and it's important,” Heinrich said. “We're providing too much inpatient care and too little right now. Hospital reform without comprehensive outpatient and acute care reform will not make a difference.”
Burish is skeptical. “In the outpatient field, it will be nearly impossible for older people, people with chronic illnesses and people with long-term care needs to find a new doctor,” he said.
Germany is also suffering from a shortage of rural clinics, as fewer doctors want to live in the countryside. The Ministry of Health wants to address this by offering extra compensation to rural clinics. Here again, Brisch is cautious: “The fact that better income opportunities are now being created does not in itself lead to an increase in rural doctors. After all, other location factors also play a role.”
One problem the new reforms solve is the cap on payments to general practitioners. Doctors have long complained about this budget cap, sometimes even going on strike, because it often forced them to treat patients for free. Lauterbach hopes that removing the cap will create an incentive for doctors to take on more patients. Heinrich welcomed the move, but said it still didn't go far enough. “The budget for specialists remains the same, so it stops halfway,” Heinrich said. “It doesn't help patients if they can get an appointment with their family doctor faster, but have to wait months to see a specialist.”
Many small changes
Some smaller reform proposals are less controversial: Lauterbach wants every patient to have a single digital medical record showing the treatment and test results of every doctor they've ever seen.
There are also plans to cut waiting times at clinics by allowing doctors to consult online or over the phone, and to prescribe a year's supply of medicines to patients with chronic diseases, who previously had to visit their doctor every three months to renew their prescriptions.
The new Krankenhaus-Atlas is already online, allowing patients to compare hospitals with an overview of treatment options, case volume, number of complications and hospital staffing levels.
Editor: Lina Goldenberg
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