Hospital reform in Germany – a balancing act between quality and coverage
21.09.2023 18:44
According to experts in vascular medicine, the planned centralization, center formation and increased outpatient care as part of the planned hospital reform makes sense and is absolutely necessary. However, until the reforms take effect, questions about financing, particularly in the aftercare of patients in outpatient care, must be answered. However, ensuring this at all times is still a challenge. This is particularly true for older people who have limited mobility. The German Society for Vascular Surgery and Vascular Medicine (DGG) will therefore discuss how quality of patient care in vascular medicine can be maintained at its online press conference on Wednesday, September 27, 2023.
The virtual press conference will take place as part of the 39th annual meeting of the DGG in Osnabrück, which this year has the motto: “Holistic Vascular Care”.
“The healthcare system in Germany is at a crucial point. After more than 20 years without comprehensive reforms, the need for action is obvious,” said Professor Dr. med. Markus Steinbauer, chief physician of the Clinic for Vascular Surgery at the Regensburg Hospital and past president of the DGG. The planned hospital reform essentially includes three key points: the establishment of specialized centers with the allocation of service groups, a reduction in the number of hospital beds and hospitals in order to redistribute the freed up financial resources and the promotion of outpatient care with the aim of reducing costs while providing comprehensive care. According to Steinbauer, together these hospital reform measures have the potential to fundamentally improve care. However, there are some challenges that need to be overcome.
Center formation not at the expense of comprehensive coverage
The creation of centers aims to achieve higher specialization and quality in the care of specific clinical pictures. In established centers, this is reflected, for example, in a reduced amputation rate due to critical circulatory problems in the legs. This can also be observed outside of Germany: Results from health services research registers show similar or even higher quality for centralized health systems such as those in Sweden or Denmark than in Germany. However, the prerequisite for better quality care is to precisely analyze the effects on the care structures in vascular medicine. “When setting up centers, we must ensure that this does not come at the expense of comprehensive care. “Specialized centers must also be accessible to patients in rural areas,” says the vascular expert.
One of the challenges would be transportation. A centralized hospital system requires a well-developed and funded transportation system. “The current transport system in Germany is not yet designed for these challenges and needs further expansion,” says Steinbauer.
In parallel with the establishment of centers, strengthen outpatient care
In parallel with the creation of centers, outpatient care should be strengthened. According to Steinbauer, there are chances of avoiding inpatient treatment for simple procedures through this outpatient treatment. But the question arises about patient safety, especially in high-risk vascular patients. Here, particular attention would have to be paid to the overall health of the individual patient and to check whether home care after the operation is guaranteed.
High strain on staff in structurally strong clinics
The reform plans could also lead to a high burden on staff in structurally strong clinics. Because emergency care primarily takes place there, as the corona pandemic has also shown. However, there are often many nursing and medical staff employed there who are hardly involved in emergency care. “This leads to a high burden on the staff in the structurally strong clinics due to emergency care and possibly to a loss of employees,” says Steinbauer. This will be exacerbated by new personnel quota requirements and rising costs for personnel, energy and purchasing with high inflation rates. “A 'cold' renovation of the hospitals will not improve the situation, but rather endanger comprehensive care and emergency care. Financial support for the clinics necessary for the future is absolutely necessary until the effects of the reform take effect in the coming years,” appeals the vascular doctor.
Nevertheless, despite its weak points, the hospital reform is an opportunity to improve care structures. Professor Steinbauer will report in detail at the DGG's online press conference on Wednesday, September 27, 2022. Other topics at the event include holistic therapeutic approaches to vascular diseases and the effects of climate change on vascular health.