The medical union demands basic corrections for hospital services. Rudolf Henke remains chairman of the federal association.
"We doctors are increasingly being instrumentalized as means of production and can no longer adequately fulfill our actual task on patients," emphasized the general meeting. This leads to increased ethical conflicts in the clinics. Curative, helping medicine is being marginalized more and more. An alternative system may continue to include the calculation of certain easily standardized services on the basis of flat-rate case fees, but it must be geared primarily to the existing, regionally different supply needs and the quality of supply. This is the only way to counteract the dominance of false economic incentives inherent in the DRG system and thus sustainably counteract the risk of medically questionable increases in volume.
"This decision is the stop sign for politics that it will not continue like this, "emphasized Dr. med. Hans-Albert Gehle from the MB regional association North Rhine-Westphalia / Rhineland-Palatinate and member of the MB federal board. The situation in the clinics is gradually becoming unbearable. "If the DRG system were drug, it would have to be taken off the market immediately because there are too many side effects," added Dr. med. Günter Jonitz, President of the Berlin Medical Association.
The medical union demands basic corrections for hospital services. Rudolf Henke remains chairman of the federal association.
"We doctors are increasingly being instrumentalized as means of production and can no longer adequately fulfill our actual task on patients," emphasized the general meeting. This leads to increased ethical conflicts in the clinics. Curative, helping medicine is being marginalized more and more. An alternative system may continue to include the calculation of certain easily standardized services on the basis of flat-rate case fees, but it must be geared primarily to the existing, regionally different supply needs and the quality of supply. This is the only way to counteract the dominance of false economic incentives inherent in the DRG system and thus sustainably counteract the risk of medically questionable increases in volume.
"This decision is the stop sign for politics that it will not continue like this, "emphasized Dr. med. Hans-Albert Gehle from the MB regional association North Rhine-Westphalia / Rhineland-Palatinate and member of the MB federal board. The situation in the clinics is gradually becoming unbearable. "If the DRG system were drug, it would have to be taken off the market immediately because there are too many side effects," added Dr. med. Günter Jonitz, President of the Berlin Medical Association.
"We doctors want medicine that does what helps the most, and not what brings the most," said MB Federal Chairman Rudolf Henke the day before in the public part of the Annual General Meeting. dedicated exclusively to the topic of hospital financing. The prerequisite for this is adequate financing of the clinics: “In the current DRG system, every provision of services must be financed by providing services.” This ultimately leads to the accusation that too much surgery is being performed in the hospitals . The MB chairman advocated paying supply surcharges to necessary hospitals in order to take pressure off the system. The security surcharge, which has already been fixed by law, is hardly used in practice because of its restrictive design. The current DRG system as 100 percent price system in connection with the strict cap on prices leads to an “erosion of ethical principles” in the clinics, warned Henke.
The withdrawal of the federal states from the is also problematic Investment financing: "The employees in the hospitals suffer every day from the fact that the investment funds are insufficient," said the chairman of the doctors' union. In order to make the necessary investments, the hospitals are forced to use resources that should actually benefit the clinic employees. Against this background, Henke pleaded for "national effort" jointly supported by the federal and state governments to adequately finance the investment costs in the hospitals: "Hospital planning and hospital financing must remain the responsibility of the state." Funding from the health insurers should be rejected because this is always the case Uwe Deh from the AOK Federal Association also said that the cost bearers involved in the planning responsibility.
Decoupling the financing responsibility from the planning responsibility will not work. The system is currently heading towards creeping monistic approach, ie the clinics will only be financed by the health insurance companies - "and the debt brake for the federal states from 2020 will certainly not increase their willingness to finance". If the trend continues and the health insurers fund the hospitals almost alone at some point, this must also result in an expansion of expertise. Deh called among other things to create scope for quality competition among hospitals for services that can be planned. In plain language this should mean that the health insurers could selectively conclude contracts with individual hospitals for such elective services.
Dr. med. Elke Buckisch-Urbanke was all too theoretical: “My patience is running out.
"We doctors want medicine that does what helps the most, and not what brings the most," said MB Federal Chairman Rudolf Henke the day before in the public part of the Annual General Meeting. dedicated exclusively to the topic of hospital financing. The prerequisite for this is adequate financing of the clinics: “In the current DRG system, every provision of services must be financed by providing services.” This ultimately leads to the accusation that too much surgery is being performed in the hospitals . The MB chairman advocated paying supply surcharges to necessary hospitals in order to take pressure off the system. The security surcharge, which has already been fixed by law, is hardly used in practice because of its restrictive design. The current DRG system as 100 percent price system in connection with the strict cap on prices leads to an “erosion of ethical principles” in the clinics, warned Henke.
The withdrawal of the federal states from the is also problematic Investment financing: "The employees in the hospitals suffer every day from the fact that the investment funds are insufficient," said the chairman of the doctors' union. In order to make the necessary investments, the hospitals are forced to use resources that should actually benefit the clinic employees. Against this background, Henke pleaded for "national effort" jointly supported by the federal and state governments to adequately finance the investment costs in the hospitals: "Hospital planning and hospital financing must remain the responsibility of the state." Funding from the health insurers should be rejected because this is always the case Uwe Deh from the AOK Federal Association also said that the cost bearers involved in the planning responsibility.
Decoupling the financing responsibility from the planning responsibility will not work. The system is currently heading towards creeping monistic approach, ie the clinics will only be financed by the health insurance companies - "and the debt brake for the federal states from 2020 will certainly not increase their willingness to finance". If the trend continues and the health insurers fund the hospitals almost alone at some point, this must also result in an expansion of expertise. Deh called among other things to create scope for quality competition among hospitals for services that can be planned. In plain language this should mean that the health insurers could selectively conclude contracts with individual hospitals for such elective services.
Dr. med. Elke Buckisch-Urbanke was all too theoretical: “My patience is running out.While we are discussing here, the employees in the hospitals will continue to be taken hostage, ”said the chairwoman of the Lower Saxony MB regional association from the hearts of many delegates. Because of the underfunding of the hospitals - Lower Saxony as an area with relatively low state base case value is particularly affected here - the doctors and nurses would have to accept emergency collective agreements or other special sacrifices. "If you do not agree, the hospital will go bankrupt, they say," said Buckisch-Urbanke. Meanwhile, the substance is endangered in many hospitals, change of direction is overdue.
How such change of direction should look like from the point of view of the MB is shown by resolution that the general meeting at the request of the board of directors after intensive discussion and numerous changes (mainly initiated by Dr. med. Christian Köhne, North Rhine-Westphalia / Rhineland-Palatinate), unanimously adopted. The wrong incentives set by the DRG system must be corrected immediately, it says: “At least where flat-rate financing reaches its limits, the system must be sensibly changed.” This concerns services that are not properly remunerated with DRG flat-rates such as extreme cost cases, organ transplant services and extensive intensive care services, expenses in the context of further training as well as to ensure the care mandate of planned hospitals and the additional special tasks of the university clinics and maximum care providers. These are to be removed from the calculation base of the DRGs and compensated for by hospital-specific surcharges.
The MB is impatient when it comes to the implementation of the compromise on further training in outpatient care, which was painstakingly found at the 116th German Medical Conference in Hanover. The doctors' parliament decided in May that further trainees in an outpatient training facility must be guaranteed that they will find at least the same collective bargaining conditions as at an inpatient training facility. A contract with the MB should ensure this. A functional organizational model is being developed between the National Association of Statutory Health Insurance Physicians (KBV) and the medical professional associations concerned for the contractual partnership on the part of the employer. This has not yet happened. Therefore, the MB General Assembly now calls on the KBV to "submit the agreed organizational model as soon as possible so that corresponding tariff structure for the remuneration of trainees at outpatient training facilities can be negotiated with the MB".While we are discussing here, the employees in the hospitals will continue to be taken hostage, ”said the chairwoman of the Lower Saxony MB regional association from the hearts of many delegates. Because of the underfunding of the hospitals - Lower Saxony as an area with relatively low state base case value is particularly affected here - the doctors and nurses would have to accept emergency collective agreements or other special sacrifices. "If you do not agree, the hospital will go bankrupt, they say," said Buckisch-Urbanke. Meanwhile, the substance is endangered in many hospitals, change of direction is overdue.
How such change of direction should look like from the point of view of the MB is shown by resolution that the general meeting at the request of the board of directors after intensive discussion and numerous changes (mainly initiated by Dr. med. Christian Köhne, North Rhine-Westphalia / Rhineland-Palatinate), unanimously adopted. The wrong incentives set by the DRG system must be corrected immediately, it says: “At least where flat-rate financing reaches its limits, the system must be sensibly changed.” This concerns services that are not properly remunerated with DRG flat-rates such as extreme cost cases, organ transplant services and extensive intensive care services, expenses in the context of further training as well as to ensure the care mandate of planned hospitals and the additional special tasks of the university clinics and maximum care providers. These are to be removed from the calculation base of the DRGs and compensated for by hospital-specific surcharges.
The MB is impatient when it comes to the implementation of the compromise on further training in outpatient care, which was painstakingly found at the 116th German Medical Conference in Hanover. The doctors' parliament decided in May that further trainees in an outpatient training facility must be guaranteed that they will find at least the same collective bargaining conditions as at an inpatient training facility. A contract with the MB should ensure this. A functional organizational model is being developed between the National Association of Statutory Health Insurance Physicians (KBV) and the medical professional associations concerned for the contractual partnership on the part of the employer. This has not yet happened. Therefore, the MB General Assembly now calls on the KBV to "submit the agreed organizational model as soon as possible so that corresponding tariff structure for the remuneration of trainees at outpatient training facilities can be negotiated with the MB".
There was no discussion during the re-election of the chairman: With 177 of the 194 valid votes, the delegates confirmed Rudolf Henke, internist, President of the North Rhine Medical Association and CDU member of the Bundestag, in his office. Dr. med. Andreas Botzlar, Bavaria. The other members of the federal executive committee were also re-elected.
Jens Flintrop
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