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BERLIN (dpa-AFX) - Ahead of consultations on the planned major hospital reform, the German Hospital Federation (DKG) has called on the federal and state governments to present a "coordinated process and schedule" for implementation. "Hospitals need planning certainty and a perspective for the future as quickly as possible in order to be able to make the locations fit for the new care tasks and care realities," said DKG Chairman Gerald Gaß on Wednesday. For many years, he said, we have been in a kind of crisis mode.

Federal Health Minister Karl Lauterbach (SPD), the health ministers of the states and experts from the coalition factions will discuss the issue this Thursday in a switching conference.

In its coalition agreement, the CDU/CSU had resolved to initiate "the necessary reforms for modern and needs-based hospital care". To this end, an expert commission was appointed last May, which has since submitted three statements with concrete reform proposals. These include more money for children's and maternity hospitals, less unnecessary overnight stays in hospitals to relieve the burden on staff and, finally, hospital financing.

The proposals on children's clinics, obstetrics and fewer overnight stays in hospitals have already been passed into law, but now it's time to implement the biggest chunk: the reform of hospital financing. Germany has about 1900 hospitals with around 488,000 beds. About one third of the annual expenditure of the statutory health insurance funds - more than 85 billion euros - is spent on hospital treatment.

The financial reform is intended to better distribute resources. The commission chairman and longtime chief physician of a Berlin clinic, Tom Bschor, had spoken of "overuse" in certain areas and "underuse" in pediatrics, for example. In an interview with "apotheken-umschau.de," he explained that Germany does spend more money on its hospitals than its European neighbors. "Nevertheless, clinics or departments are struggling to survive financially and yet there are major quality deficits: strokes, for example, are not treated exclusively in departments with a special stroke unit and cancer diseases are too often not treated in certified cancer centers."

The federal and state governments are now discussing the concrete implementation of the following proposals made by the commission:

- Less "general store," more specialization. Hospitals should be given specific mandates as to which different services they should perform (service groups) - for example, kidney, heart or gastrointestinal treatments - instead of maintaining a general specialist department of internal medicine, in which then possibly "even a small, poorly equipped department may do everything from acute heart attacks to complex cancer," says Bschor.

- According to the proposals, hospitals nationwide would also be uniformly assigned to three levels and funded accordingly: Hospitals providing basic care, hospitals providing "standard and specialized care," and "maximum care hospitals" such as university hospitals.

- The so-called per-case flat rates are to be significantly reduced. Hospitals currently receive a flat-rate euro amount per patient or treatment case. According to Lauterbach, this leads to a "hamster wheel effect" of performing as many treatments as possible in the cheapest way possible, which can cause quality to suffer and put further pressure on scarce staff. According to Bschor, decreasing flat rates would reduce the incentive to, for example, "install knee prostheses even when there is a questionable indication," and free up money for so-called advance services.

- According to the reform proposals, hospitals would receive fixed amounts in the future for, among other things, the provision of staff, an emergency room or necessary medical technology ("Vorhalteleistungen"). "Like the fire department, which is not only paid when there is a fire," says the head of the expert commission.

The plan is a long-term project. Lauterbach had spoken of a "revolution" for clinics. "Medicine will once again be placed in the foreground of therapy and not follow economics," the minister said last month. Bschor believes it is "not illusory" that the reform could be implemented legislatively this year and come into force at the beginning of 2024. The commission then recommends a five-year transition period "in which the system is converted piece by piece."/jr/DP/ngu