Transparency in hospitals: Exchange of blows focused on finances
Against the background of hospitals’ great financial difficulties, the Bundestag debated the Traffic Light Coalition’s draft of a “Hospital Transparency Act” in its first reading. The draft law requires the Federal Ministry of Health to publish current and continuously updated information about the range of services and the quality of inpatient care in Germany. This is intended to enable patients to obtain appropriate information about the services and quality of the hospitals.
Lauterbach insists on “overdue” transparency
The transparency law on the quality of care in hospitals is “long overdue,” emphasized Karl Lauterbach: “We can no longer leave people alone with this existential question.” In the case of breast cancer, mortality is 25 percent lower if patients are treated in a certified breast cancer center. There are similar differences in mortality in the treatment of colon cancer and heart failure.
Lauterbach countered the argument that the Transparency Act would create a bureaucratic monster by saying that available routine data would be used for the evaluation: “The sad thing is that we have the data. But we never published it. That can’t be right,” said Lauterbach. Small clinics in particular often achieve the best treatment results as specialist clinics. A further delay in transparency is “cynical” because it would continue to fill hospitals that do not address quality deficiencies.
So far 1,000 pages about a clinic
The SPD health politician Matthias David Mieves pointed out that the current quality reports on the hospitals were already available online in the transparency register of the joint federal committee – but were incomprehensible as a PDF file with over 1,000 pages for a single clinic. Mieves said: “We need the right information so that it is reliable and understandable for everyone in this country.” Both Lauterbach and Mieves alluded to the fact that knowledge of good treatment centers is still privileged.
The hospitals should be assigned to different levels of care, including special levels for specialist hospitals and cross-sector providers. The opposition fears that this will direct patient flows at the expense of smaller hospitals. The federal government emphasizes that the planned transparency will have no impact on the states’ hospital planning or hospital remuneration. The definition and design of the service groups will remain the responsibility of the hospital reform and the agreed procedure for defining and further developing the service groups will be retained.
Armin Grau from the Alliance Greens described the fear that the transparency law was an anticipation of the hospital reform as “fear-mongering”. He defended the planned transparency as a trust-building measure that helps patients make self-determined selection decisions. Grau emphasized that the transparency created “in no way interferes with the planning sovereignty of the states”. The planned stages would be informative, the states would assign the performance areas: “There is no competition, there is no fit between the federal government and the states.”
The question of financing dominates political debate
Politicians from all opposition parties rejected the law on the grounds that the federal government must first ensure the financing of hospitals. Only then can we ensure more transparency in the quality of care. Federal Health Minister Karl Lauterbach pointed out that the federal government had supported hospitals with 21 billion euros during the corona pandemic and with a further 6 billion euros to cushion the energy crisis as a result of the Ukraine war. The countries, on the other hand, have not paid 30 billion in investment costs in the last ten years.
The current protests against the federal government therefore border on “hypocrisy because the federal government has always paid.” The health policy spokesman for the CDU/CSU parliamentary group, Erwin Rüddel, justified the Union’s motion entitled “Enact a preliminary law now and prevent cold structural adjustments in the German hospital landscape” with the argument that financial compensation is urgently needed for the coming months. The CSU politician Stephan Pilsinger listed numbers:
Many hospitals are not economical
At the end of 2022, 20 percent of the 1,700 hospitals in Germany would be in loss, by the end of 2023 already 50 percent and by the end of 2024 around 70 to 80 percent. In 2024, 31 percent of hospitals will be at acute risk of insolvency. The federal government is to blame.
The liberal health politician Andrew Ullmann pointed out that the Bavarian Hospital Society sees the Bavarian state government as having the opportunity to compensate for the deficits by at least doubling the investment costs. The Green politician Johannes Wagner countered the Union politicians by saying that Bavaria, among other things, was blocking the necessary hospital reform, which was intended to prevent this by abolishing the flat-rate system.
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