The German Medical Association publishes theses on the economization of medical professional activity

30.09.2022 17:20

"Our healthcare system is becoming more and more in trouble. A key reason for this is the commercialization of medicine, which has been pushed forward by politicians for decades. But when business goals become the focus, medical independence is at stake - and with it Safety and well-being of patients." This explains Dr. Klaus Reinhardt, President of the German Medical Association (BÄK), on the occasion of the presentation of the BÄK's "Theses on the economization of medical professional activity".

Of course, in a health insurance system designed as a solidarity community, there is an obligation to act economically, emphasizes the BÄK in its paper. “But if the economic evaluation criteria are given overweight, purely economic goals will gradually become the new goals of medicine,” it continues. The DRG system for hospital financing provides incentives to increase the number of cases, devalues the quality of indications and rewards activism. From the BÄK's point of view, what is also lost is the awareness of the possibility that good medical action can also consist of omission.

For this reason, Reinhardt calls for a comprehensive reform of hospital financing. “The flat rate per case system has failed. It leads to fundamental mismanagement because it motivates hospitals to organize themselves along industrial lines. However, important aspects of medical work are not rewarded, such as caring for patients.” It is therefore fundamentally to be welcomed that the federal government is planning to reform hospital financing. “The system must finally be put back on its feet,” said Reinhardt.

The BÄK's theses paper contains a number of suggestions as to what such a reform could look like. What is needed is a financing system that encourages doctors to do justice to individual patients. The BÄK also calls for the actual staffing needs to be measured realistically and to focus on patient care. In contrast, the previous quantitative remuneration characteristics would have to be reduced. “A new remuneration system must reflect the differences in the cost structures of hospitals more clearly,” says the paper prepared by the BÄK’s Committee for Ethical and Medical-Legal Questions. “It should combine flat-rate remuneration components that are independent of revenue to cover maintenance and personnel costs that are independent of the number of cases, as well as remuneration components that are dependent on the number of cases.”

The BÄK also sees financial mismanagement in the outpatient sector. The uniform assessment standard also provides incentives for through-feeding medicine while accepting a restriction in psychosocial care. She warns against repeating the mistakes made in inpatient care in outpatient care when introducing the so-called hybrid DRGs. “Hospitals and outpatient practices are part of public services and must be operated in such a way that their orientation towards patient well-being is recognizable and maintained,” warns the BÄK. To this end, the independence of treatment decisions must be protected and medical decisions must be prevented from being based on business indicators.