At the kick-off event for World Patient Safety Day 2023, Federal Health Minister Prof. Dr. Karl Lauterbach did not address the demands of Dr. Ruth Hecker, chairwoman of the Patient Safety Action Alliance, in her opening speech. In her opening speech, she urged him to "strengthen the voice of patients" and called for "patient experiences to be recorded nationwide through standardized and cross-sectoral surveys." Lauterbach, however, did not deviate from his speech script, drawing a suspenseful arc over the healthcare reforms already prepared, adopted, planned, and contemplated (and even previously unknown) during his term in office. When asked why these were only coming now, and so late, he replied: "Then I should have been elected earlier."

>> Surely to the relief of the APS chair, Lauterbach confirmed that patient safety is a "very important issue" that "pervades our work as a team in the Federal Ministry of Health" – this applies to all laws currently being drafted and adopted, as well as patient rights and prevention laws. Unlike APS chair Dr. Ruth Hecker, who in her opening speech referred to the WHO's Global Action Plan for Patient Safety and criticized the fact that the current Hospital Transparency Act, while addressing key structural criteria, fails to mention the term patient safety at all, Lauterbach used his speaking time to deliver a comprehensive review of the health legislation he has passed so far in office.
According to him, the quality of the outcome is the most important parameter to be considered in all laws. It is of no use if a treatment and care process goes well and everything is perfectly documented, but in the end the survival rate is not as good as it could have been. At 12.8 percent of gross domestic product, Germany has the most expensive healthcare system in Europe, yet life expectancy trends are unsatisfactory. Despite its expensive system, Germany has not yet been able to influence life expectancy as positively as many other EU countries – such as Spain, Portugal, Italy, France, Belgium, Sweden, Finland, Norway, and Denmark – on the contrary. With each year, Germany's life expectancy trend gets slightly worse.
Lauterbach continued, stating that he had written an article on this topic together with Professor Dr. Stephan Baldus of the University Hospital of Cologne, even though he had "little time for scientific work." This article (see page 40) explores the fundamental problem and why Germany performs so poorly in terms of life expectancy. This despite the fact that much has actually been done in this country – starting with preventive and minimum-quantity laws and structured care programs. Nevertheless, life expectancy in Germany is declining for the third year in a row.
"Certainly also due to coronavirus," Lauterbach qualified. However, for coronavirus to have reduced life expectancy, many affected individuals must have had pre-existing health conditions, increasing the likelihood of later developing heart attacks, strokes, diabetes, or even dementia. Lauterbach added: "We have to expect a wave of dementia because we know that in older people who have pre-damaged blood vessels in the brain and contract COVID, these vessels are often more severely damaged." The same applies to strokes. "We have important challenges ahead of us," the Federal Health Minister stated, setting the tone. "We have something we can and must work on," because we know the problems quite precisely.
To do this, one must first look at the problems and their findings, which are often old but nevertheless relevant. It is a fact, for example, that there are very large differences in life expectancy of around ten years between rich and poor in the lowest and highest quintiles. To illustrate this discrepancy, Lauterbach developed the thought experiment of a miracle cure: What would happen if, for example, it were possible to cure all cases of cancer? Then, the minister said – which is a good thing – life expectancy in the entire population would increase by two to three years. But what kind of huge factor would it take, he asked his audience, if the difference in life expectancy between rich and poor is ten years? Major factors are needed to significantly reduce this difference – but there is very little useful research on this in Germany, and what's more, research that needs to start very early. For example, in the prevention of heart disease, where one has to start with children. Many parents simply don't understand that their children are very likely to have risk factors if early heart attacks and strokes occur in their family. Therefore, in some countries, children are specifically screened for these risk factors during the transition to adulthood. However, this is not the case in Germany.
The same applies to lipoprotein "small a" (Lp(a)), a genetic risk factor that makes women more prone to miscarriages and, later, to strokes and heart attacks much earlier. Lauterbach: "But this can already be detected in children." And then treatment can be given accordingly, which could delay strokes until much later in life. Lauterbach: "But this isn't even being investigated in Germany." His approach is therefore to work more systematically than before and, above all, to protect young people from long-term effects, something that has long been done in other countries – especially Scandinavian ones – whose life expectancy is therefore much better than in Germany. To change this, he announced his intention to introduce a law to strengthen early detection for many risk factors. This should then be “a good prevention law,” but not prevention, which is certainly partly health insurance marketing that only exists to bring positive contribution margins into a health insurance fund, but is certainly not capable of addressing the ten-year difference in life expectancy between rich and poor.
However, according to him, not only prevention plays a major role, but also hospital care – here, too, there are very large differences in treatment in Germany. For example, mortality is 25 percent lower if breast cancer surgery is performed in a certified oncology center – at the same stage of the disease, mind you. Lauterbach: "That's one in four women, which is extremely significant." This raises the question, he says, "why don't we treat everywhere like we do in certified treatment centers, thus saving one in four women?" This is a question that must be investigated and addressed, as the "enormous hospital law" is now doing.
The goal, he says, is that in the future, in principle, everyone will be able to receive virtually the best treatment in the hospitals. This is also the reason why all German university hospitals, the German Cancer Society, many other professional societies, and the Association of Medical Scientific Societies are behind this reform, something one rarely sees in an SPD-led healthcare reform. Of course, there are also conflicts, for example with private hospital operators. The argument here is that not every seriously ill patient can be treated in a specialized hospital; there aren't that many specialized hospitals. His rhetorical counter-question: "How do the Scandinavian countries do it?" The solution, he says, is that not every patient has to go to a specialized hospital, but rather that every hospital should be treated as well as they would in a specialized hospital. Given the enormous hospital density in Germany, any longer travel time would be negligible; in fact, it would only add a few minutes. In any case, he doesn't know a single patient who would trade a slightly longer travel time of perhaps 20 minutes for a 25 percent risk of death.
However, this requires transparency. The Hospital Transparency Act, which is intended to clarify where quality is good and where it is not, is rejected by some federal states. Lauterbach stated that the argument is that if the differences in results were made public, some hospitals that already have quality issues would no longer fill up. Lauterbach asked, "But are these hospitals supposed to fill up with cancer patients, for example?" And addressed the audience, "With them, with their relatives, their mother or their father?" Transparency is therefore an important prerequisite for better quality – and patient rights are also rights to information.
Take stroke care, for example: emergency services would drive to those hospitals that had registered for emergency admissions, thus often bypassing the hospital that would have been better suited to stroke care. "According to calculations by our government commission, we lose around 5,000 people every year who do not survive a stroke," explained the Federal Minister of Health. And this despite the fact that care in a specialized hospital is no more expensive and is probably even cheaper due to fewer complications. Lauterbach: "That, too, is very significant." In addition to the approximately 5,000 people who died in vain, there are also those "who survive but then require nursing care." Therefore, in his opinion, stroke care in stroke units must be significantly expanded. After the initial investment, this would cost little because subsequent costs would be avoided, even to the point of being budget-neutral.
However, there is another type of care in Germany that is even more precarious: that which takes place in a kind of parallel structure, or usually does not take place at all. This is why health kiosks are necessary. He rejects the often-heard counterargument that this would take work away from practicing physicians: "In the districts where there are already no general practitioners, none will be able to go." In his view, health kiosks represent a care structure for those who otherwise have no care at all and who – if they become seriously ill or complications arise – have to be transported to an emergency room or university hospital at great expense and treated there. Health kiosks like "Die Kümmerei," which he recently visited in Cologne, are better and more efficient. Furthermore, they provide care to people who have no health insurance at all, and they work in 14 languages.
Finally, Lauterbach addressed several points that were equally important to him. First, the electronic patient record. The treatment data stored therein not only helps improve care, but also supports patients when a second, supported opinion is needed or when actual treatment errors have occurred. These are much easier to prove once the documentation has already been completed, at a time when it wasn't even clear that one could ever develop. Lauterbach: "If all the important data is collected in the electronic patient record, patients have a completely different situation." The Health Minister made his second point regarding the attempt to increase pharmaceutical production in Germany and Europe to avoid supply bottlenecks – the necessary legislation had been left pending for ten years. "If you now say," Lauterbach addressed the audience again, "that everything should have happened much sooner," then – in his own words – "I should have been elected to office sooner."
His final points: hardship funds, a readjustment of the burden of proof, and the Patient Rights Act. While he didn't want to anticipate the key points of the law, one important point was access to patient records, and another was perfectly guaranteed data protection and data security. Lauterbach's plea, addressed to the Patient Safety Action Alliance: "Don't let yourself be unsettled. Those who shy away from the transparency of electronic patient records will try to use data protection as an argument to win you over to those who later reject transparency. Think about it carefully: In the end, it's your data that you don't have now." According to Lauterbach, the most important work for improving patient safety is and remains, on the one hand, better prevention, and, on the other, better quality of treatment. His promise: "We will work consistently on both. I invite you to accompany us on this path."