Zi presents an analysis of state legal requirements for the remuneration of the emergency services
26.10.2023 14:32
The health policy discussion about how scarce human resources, in particular in acute and emergency medicine, can be used efficiently and those seeking help can be directed to the care that is appropriate for them, has recently gained momentum again. In its recently presented recommendations for reforming the emergency services, the “Government Commission for Modern and Needs-Based Hospital Care” once again advocated closer digital integration of the central telephone numbers 112 and 116117.
In order to use scarce resources more efficiently, processes in the service centers of the statutory health insurance associations and in the rescue control centers must also be coordinated. This is partly made more difficult by the fact that, as the government commission states, “the legal framework of the rescue service, the details of its organization, implementation and financing are often regulated differently in the 16 state rescue service laws”.
Overview of the legal basis and the framework conditions for financing the rescue service at the state level
Against this background, the Central Institute for Statutory Health Insurance (Zi) announced on October 23rd. published an “Analysis of the federal state legal framework for the use and remuneration of emergency services” commissioned by the IGES Institute. “With the current report, we now have an overview of the legal basis and the framework conditions for financing the rescue service at the state level,” said Zi board chairman Dr. Dominik von Stillfried in Berlin today.
The cost recovery principle applies in 14 of 16 federal states
“In principle, the financing is based on a full cost consideration. This also includes the costs of training emergency paramedics. The cost coverage principle explicitly applies in 14 of 16 federal states. However, the explanations for implementation at the state level sometimes differ considerably,” continued von Stillfried. While in the federal states of Hamburg, Berlin and Bremen, for example, all expenses could be passed on to the GKV via the state fee schedule, in most states a different duality between flat-rate investment cost reimbursements and usage fees per trip must be taken into account.
Passing on the savings achieved is difficult
However, all emergency services laws allow patients to be transported to or referred to a suitable facility. In the future, in addition to hospitals, this could increasingly include doctors' practices that can integrate relevant acute cases into their practice processes and make themselves available as contact points. Initial approaches to this already exist in many federal states. However, passing on savings achieved, for example through avoided hospital treatment, shorter ambulance retention times or even avoided ambulance deployments, is still difficult, not least because of the different consideration of investments or maintenance costs in conjunction with restrictive regulations in Social Code V.
Associations of statutory health insurance physicians are not allowed to remain stuck with costs
“For the associations of statutory health insurance physicians, which cover most of the costs for the mobile on-call service and the operation of the telephone number 116117 from their own budget resources, i.e. ultimately from contributions from practicing doctors, this can create hurdles for better cooperation with the emergency services. If the Association of Statutory Health Insurance Physicians takes over those calling for help from 112 and saves calls from the emergency services by providing telephone medical advice, there is currently no counter-financing for these investments. If the potential for better control in acute and emergency care is to be exploited, the associations of statutory health insurance physicians cannot remain stuck with the maintenance costs for the medical on-call service - organization, technical implementation, construction and operation of the 116117 control centers and service centers," emphasized von Stillfried.
Significant unequal treatment of the outpatient care sector
He further criticized: “We currently see considerable unequal treatment of the outpatient care sector in the existing regulations on the emergency services, which, despite all the heterogeneity in state law, largely provide for the cost-coverage principle. The government commission has also determined that remuneration for medical on-call services is based solely on performance using a uniform assessment standard. “As a result, services provided, for example for the control center 116117 and the on-call service, are not remunerated in a way that is commensurate with the effort involved,” says the commission report. Politicians should now quickly remedy this situation. This can make a decisive contribution to limiting costs, particularly for ambulance operations.”
The costs of emergency services have risen sharply in recent years
The costs for emergency services in Germany have risen sharply in recent years - to a total of 8.4 billion euros in 2022. They therefore account for almost ten percent of expenditure on hospital treatment. That is more than ten times what the statutory health insurance (GKV) spends on the medical on-call service (ÄBD). A major driver of expenditure was the use of ambulances. This accounted for around 4 billion euros in 2022. In 2017 it was 2.3 billion euros. That's a cost increase of 75 percent in five years. If you look back to 2010, expenses for the ambulance have almost quadrupled from 1.3 billion euros back then. The specific cost increase in the period from 2010 to 2022 was an average of 9.7 percent per year, significantly higher than the total GKV service expenditure (4.3 percent).