The Federal Council dealt today. Various federal states have tabled amendments. Bavaria wants to keep the supply surcharge of 0.8 percent per DRG case after all - just as the hospitals had recently loudly demanded. The chairman Rudolf Henke explains what still needs to change from the point of view of the Marburger Bund.
Five questions for ... Rudolf Henke, 1st Chairman of the Marburger Bund
DÄ: The federal states today presented various proposals to the Federal Council to change the planned hospital reform. Does that surprise you? Henke: Yes, little. After all, the current draft of the Hospital Structure Act is based on the cornerstones that the federal states helped to develop. There is still lot in motion for the fact that there was federal-state working group.
DÄ: And how do you evaluate the proposed changes? Henke: We are also of the opinion that there is still lot to change in the bill. The hospitals must be able to trust that the collective wage increases will be fully refinanced in the future. In recent years the gap between the tariff increases and the actually realized increases in the state base rates has widened. In 2015, she put the underfunding of the hospitals at 2.5 billion euros. If the calculation is correct, it is no trivial matter. Therefore, the wage results must be fully recognized as economic costs for the refinancing of personnel costs.
DÄ: The federal government wants both for hospital planning and for the Introduce hospital financing quality parameters. Sounds quite reasonable ... Henke: The quality of the hospital services provided will only improve if there is sufficient staff available who can provide these services. The reality, however, is that the number of cases treated in hospital has been increasing for years while the length of stay is falling. The houses also care for more and more emergency patients. As result, the work density for doctors and nurses has been increasing for years. Because the personnel resources are not keeping pace with the intensification of performance. Sufficient staff is essential for quality. A quality offensive is only conceivable as part of personnel offensive.
We therefore think it is good that after the summer break commission of experts should examine whether the staffing levels in hospitals are still appropriate in view of the increasing number of people with dementia. However, this must not only focus on the number of nurses, but must also take into account the staffing in the medical field.
DÄ: The Marburger Bund has drawn up ten demands that are to be implemented with the hospital reform. You have already mentioned some of them. What else do you have? Henke: It is simply essential that the federal states provide their hospitals with enough money for investments. In the past few days I have been to several hospitals to see the situation on site. There I was confirmed that the houses are taking part of the DRG proceeds, for example to invest in renovation. But then there is no longer any money for hiring more staff, which would actually be necessary. That can't be true.
I believe that today many federal states are hiding behind the complexity of the matter. We can't let them get away with that. We have to explain to patients why doctors and nurses in hospitals often seem so exhausted and rushed: because many hospitals do not receive enough money to invest and therefore have to cross-finance. Only when the patients understand this will the pressure on the federal states become so high that they will make more money available to their hospitals again. This is already happening in some countries, most recently in Baden-Württemberg. So we have to keep up the pressure on the countries. Because nothing more will change in the parliamentary process with regard to the financing of investment costs.
DÄ: Many doctors are fundamentally critical of the DRG system. Wouldn't this have been good time to take up this criticism and reorganize the DRG system? Henke: The DRG system is well suited to paying for similar services straight away. Much can not be mapped with the system. If, for example, hospitals train more young doctors, this is not reflected in the flat-rate case fees. Or when hospitals treat more patients with rare diseases. It's not fair. However, it is also difficult to map these differences in the DRG system.
In this respect, I think it's not bad if certain hospitals are now to receive supplements, for example because they treat more emergency patients or are located in regions in which they can generate less revenue than they need - but in which they are urgently needed. The problem is that there should be no legal entitlement to these surcharges, but that they should be negotiated between hospitals and health insurance companies. So far, the health insurance companies have hardly paid any security surcharges. I am very curious to see whether this will change with the new regulations.