The German healthcare system is increasingly running out of money – also because the hospitals are so expensive.

Since the income from contributions to statutory health insurance (GKV) is less and less keeping pace with expenditure, a financial reform is needed.

Minister of Health Karl Lauterbach (SPD) has already made corresponding proposals several times for “the next few days”, most recently at a reception of the AOK Federal Association last week.

However, a draft cannot be expected before the end of May.

After all, Lauterbach already has ideas about where the fresh money should come from: from increasing cash contributions, higher federal grants and from the financial reserves of the insurance companies.

All of this affects income.

Lauterbach rules out the possibility that there will be cuts in services on the expenditure side.

Christian Geinitz

Business correspondent in Berlin

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However, he speaks of optimizations in the hospital system, and he wants to achieve this through a hospital structural reform.

The coalition agreement provides for a government commission to be set up for this purpose, the composition of which has been fixed since Monday: 15 scientists belong to it, including lawyers, economists, nursing experts, pharmacists and doctors, such as the President of the German Society for Internal Intensive Care and Emergency Medicine, Christian Karagiannidis.

reduction of beds

Also noteworthy is the appointment of the Berlin professor for management in health care, Reinhard Busse, who calls for the intelligent reduction of hospital locations and beds in order to improve the quality of care.

This is exactly what the reform is about: increasing the quality of care, for example by allowing the federal government to play a greater role in hospital planning.

Critics complain that this is still too often determined by state and municipal interests, which lose sight of patient care.

The second major topic of the planned reform is the change in the diagnosis-related case flat rates (DRG).

These, according to the accusation, are not sufficient for the very small as well as the very large houses or create false incentives.

Last but not least, there is talk of pushing back inpatient admission in favor of outpatient clinics, which are significantly cheaper and less staff-intensive.

A comprehensive reform of the structure and financing of the clinics is overdue, confirms the Frankfurt medical professor and chairman of the expert council in the health system, Ferdinand Gerlach.

The separation of inpatient and outpatient care came about more than 100 years ago.

"This is now outdated and can no longer be financed," he told the FAZ. "It doesn't fit into a time of specialization and digital networking." Heart attacks or strokes are treated much better in specialist centers, cancer requires personalized high-tech medicine, "which not every small hospital can offer in the required quality".

Health centers close to home are needed in rural areas.

They could focus on outpatient medicine, but also maintain beds,

Lobbies feel left out

Gerlach thinks it is right that the self-government in the health care system should be consulted by the new commission, such as the health insurers or the clinic and doctor associations, but that these "benches" are not directly represented in the council: "The necessary reforms, for example at reducing oversupply in the interest of patients, deploying employees in a targeted manner and observing the principle of 'quality before proximity' have so far been prevented or slowed down by influential interest groups."

The lobby groups naturally see things differently.

Although they welcome the establishment of the Commission and are available for advice, they feel left out.

"It's not about discussing scientific models, but about designing actual framework conditions for the care of 83 million people," says the German Hospital Society DKG.

The National Association of Statutory Health Insurance Funds criticizes: "It would have been better to anchor the commission appropriately in the healthcare system, because in addition to scientific theory, such a reform also needs the conceptual and implementation competence of self-government."

Bavaria's Health Minister Klaus Holetschek (CSU) railed: "Hospital planning belongs in the hands of the federal states.

It is completely unacceptable that the Federal Ministry of Health will not involve the federal states as members in the formation of the government commission.”