SURVEY: GP-2025/7: Schrappe

None of these laws make sense to pursue further. The healthcare system in Germany is in serious crisis.

In addition to the well-known phenomena of sectorization, therapy-focused care, and the emphasis on institutional logics rather than the patient perspective, a serious undersupply has now increasingly emerged, a phenomenon that in the past we had only located in purely market-based (USA) or public health systems (UK). The hectic polypragmatism of health policy over the past three years has not provided any relief in any area, but has instead deepened the problem: a move away from evidence-based benefit assessment (Healthy Heart Act), excessive centralization at the federal or BMG level (e.g., the Expert Council on Quality Assurance within the BMG), the disempowerment of the Federal Joint Committee (G-BA), the strengthening of the volume incentive (minimum reserve numbers), the misuse of the quality concept (transparency directory based on far too large service groups), and, above all, a renewed attempt to reform the hospital system through yet another sectoral optimization strategy. This activism (doing everything at once, without consultation, without involving the meso-level, a coalition course with the federal states, and no involvement of the regions) destroys more than it can ever improve. The crucial reason lies in this: there is no adequate analysis of the goals of such reform steps; there are no clues for a strategic selection of the most important problem areas and the appropriate means for meaningful change management. Instead of picking out individual pieces in the middle of the election campaign, a thorough analysis is needed first – after the federal election – that will result in a feasible and promising concept for the further development of the healthcare system and for legislative initiatives. Everything else remains piecemeal, which continually worsens the situation, while contributions for insured persons and employers continue to rise. In short: stop, analyze, develop a strategy, and re-establish targeted activities."