Before the hospital reform decision was taken, the Hessian hospital company warned of impending insolvencies. Doctors and experts believe a new care system is necessary, but Federal Health Minister Lauterbach’s plan is inadequate.

By Jutta Nieswand

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“The situation is more dramatic than ever before,” says Steffen Gramminger, managing director of the Hessian Hospital Society (HKG). For many hospitals in Hesse, things are more than financially tight. “80 percent of all clinics in Germany and therefore also in Hesse are in the red,” says Gramminger.

Some clinics would have to check practically every month whether they would have to file for bankruptcy. Two hospitals in Hesse recently did this, the DRK Hospital Biedenkopf and the Scivias Caritas Clinic in Kiedrich (Rheingau-Taunus). According to the HKG managing director, with a double-digit number of houses in Hesse alone, it is uncertain whether they can continue to exist. Overall, the deficit in hospitals in the country has grown to one billion euros.

Further information

The planned hospital care improvement law by Federal Health Minister Karl Lauterbach (SPD) has been discussed for a long time. The federal cabinet wants to decide on it next week. The discussions are likely to continue afterwards, especially since the federal states have a say in health policy. For one day, the hr deals with the topic in all broadcast channels.

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Steffen Gramminger cites a lack of inflation and tariff cost compensation as reasons, as well as increased wages and salaries as well as high energy and material costs. The HKG boss assumes that the economic situation of the clinics will continue to worsen.

Reinhard Schaffert, the managing director of the Hesse Clinic Association, which represents the municipal hospitals, comes to a similar conclusion: “Hospital treatment does not cover costs.” The so-called state base case value, the basic price for treatment, has increased less than the expenses.

Declining number of treatments

Schaffert also points out that the number of treatments did not only collapse during the corona pandemic. Since then, the number of cases has been below the level of 2019. This is having a negative impact on the hospitals’ budgets. Ultimately, the clinics are dependent on as many treatments as possible because they are largely financed through flat rates per case, explains the head of the clinic network.

Federal Health Minister Karl Lauterbach (SPD) wants with his Hospital reform Create a remedy. The per-case flat rates should only make up 40 percent of the financing. The health insurance companies should cover 60 percent through basic financing, regardless of the number of cases. This should make the clinics economically less dependent on how many patients they treat. This is intended to help ensure health care, especially in rural areas.

At the same time, the federal government wants the clinics to specialize more. The federal states should assign so-called performance groups to the individual houses. Certain operations should then only take place where the standards for them are met. Particularly in cities, clinics are likely to close some departments or close them entirely.

“The biggest problem is insecurity”

In the Sachsenhausen Hospital in Frankfurt, for example The obstetrics ward will be closed on July 1st. They have been around for almost 100 years, but recently the number of births there has fallen significantly. In the course of the upcoming hospital reform, the hospital must concentrate on certain service areas, says managing director Claudia Fremder: These include the diabetes specialist clinic, the oldest in Europe, and the obesity reference center, the largest in Germany.

The announced reform is causing a lot of uncertainty and fear among doctors, reports Elke Jäger, who heads the department for oncology and hematology at the Nordwest Hospital in Frankfurt. Nobody knows yet which house specializes in how. This has already led to an exodus of doctors, so that operations in some Hessian hospitals are at risk.

“The big problem is the lack of clarity,” says Manuel Zelle, managing director at Frankfurt Hospital Northwest. There have been various drafts for the reform for two years, but no result. “We need a certain level of planning security, for example for the purchase of large equipment, for renovations, for investments,” emphasizes Zelle.

Experts do not expect any undersupply

Wolfram Burkhardt, Professor of Health Economics at the Frankfurt University of Applied Sciences, expects a reorganization of the clinical landscape to offer good opportunities for greater quality and better security of care. “The risk lies in a reform from above that doesn’t really take into account the needs of the population,” he says.

Burkhardt has observed that the hospitals are already in the process of specializing and defining service areas for which they are guaranteed a guarantee of existence by politicians. Regarding the fears in the population and in the clinics, he says: “I don’t suspect that there will be an undersupply and that hospitals will simply be closed from above.”

Health insurance companies believe reform is unavoidable

Ingo Tusk, head of the Endo-Prosthetics Center at the Frankfurt Red Cross Clinic, believes that basic care must be maintained in the city and especially in the countryside. In acute emergencies, such as a heart attack or appendicitis, patients need to be treated quickly. This requires short distances. “That’s why the small clinics have to be preserved,” says Tusk.

On the other hand: With planned interventions, patients can be expected to go further, says Tusk. A specialized, well-rehearsed surgical team delivers correspondingly better treatment results. From Tusk’s point of view, this is an important argument for the desired specialization of hospitals.

For the Hesse Association of Statutory Health Insurance Physicians (KVH), it is completely undisputed that the hospital landscape needs to be reformed. Germany has far too many small clinics that cannot offer reasonable care in all areas of medicine. Instead, medical and nursing resources would be tied up in the wrong places – an even bigger problem in times of a shortage of skilled workers.

Concern about outpatient care

The KVH is calling for a hospital reform that controls patient flows based on the qualifications of the hospitals. However, when asked by hr, a KVH spokesman expressed the fear that Federal Health Minister Lauterbach’s plans would lead to outpatient specialist care being destroyed. There would then no longer be any care close to home in general practices and specialist practices. Resident specialists would be demoted to auxiliary workers in hospitals and would only be expected to fill their beds. The KVH emphasizes that outpatient care needs to be strengthened.

It is important that clear rules are drawn up quickly – also for better cooperation between inpatient and outpatient facilities, says oncologist Elke Jäger from the Frankfurt Nordwest Hospital. This would create synergies.

It’s not just about hospital reform, but about comprehensive health care reform, says Martin Hussing, nursing director at the Nordwest Hospital. The current draft law falls short for him. Hussing would have hoped for a vision of how “patient-oriented medical and nursing services” could be achieved in Germany: “There are countries that are 100 years ahead of us, especially when it comes to nursing.”

Hospital company: State has to pay more

Steffen Gramminger from the Hessian Hospital Society considers the previous reform plans to be well-intentioned but poorly executed. The so-called reserve financing is correct, but the proposed regulation is too complicated and bureaucratic. In addition, he fears that the separation between outpatient and inpatient areas will lead to duplicate examinations and additional costs.

Ultimately, every federal state is positioned differently, says Gramminger: “In Hesse, the investment funds were increased four years ago, but it was still not enough.” The clinics received 390 million euros from the state, “about 150 million euros were still missing,” calculates the HKG director. The new government’s double budget has earmarked 550 million in investment funds. Gramminger believes “that the sins of the last ten years cannot be repaired” and calls for immediate aid.

Hessian Health Minister: The federal government also has to pay

Basic approval for a hospital reform also comes from the new Hesse Health Minister Diana Stolz (CDU). “From the perspective of the federal states, the current draft bill is in great need of change,” she writes in response to an HR query. The reform must work in practice and therefore take regional particularities into account.

And of course it’s about money. The states would have to finance the necessary investments; Hesse has done its job here, says Stolz. But the federal government has to bear the operating costs, especially since they are “getting out of control,” as the Hessian health minister emphasizes: “Even with the necessary transformation costs, the federal government must not duck away.” The hospital reform will cost so much money that contributors and the states cannot raise on their own.