The fourth statement of the government commission for modern and needs-based hospital care had already dealt with the reform of emergency and acute care by pointing out the need to consider the entire system. The 9th statement focuses on the quality of care and is dedicated to questions of financing and transparency in order to implement the right to emergency services as a separate service segment in SGB V, which was already announced in the coalition agreement. At the same time, many new tasks are coming to health care research to.

>> The recommendations of the government commission on emergency services in this statement are based, among other things, on a review and analysis of the numerous reports and statements already available - such as those of the Expert Council for the Assessment of Developments in the Health Care System from 2018 and the work of Krafft et al. on behalf of the Bertelsmann Foundation and in collaboration with the Björn Steiger Foundation 2022.
After an introductory definition of the term “emergency service” and its task, the legal framework and the rescue service provider - there are currently almost 300 independent emergency service areas with around 240 control centers with 13 different organizational forms - the statement deals with remuneration models. These vary regionally, which would make transparency of the costs and services of the rescue service (including the control centers) and thus comparability considerably more difficult. The basic criticism: “There is therefore a coexistence of remuneration models (negotiations with the cost bearers) and municipal fee models. The latter follow a full cost recovery principle at the expense of the cost bearers without any incentive for economically efficient operation." Due to a lack of transparency, it is also unclear to what extent states and municipalities will cover the investment costs for the rescue service or to what extent they will include these costs in the fees or charges to be borne by the health insurance companies. Include fees.
According to the commission's recommendation, the rescue service should in future be transferred to SGB V as a separate service segment in order to regulate - similar to hospital treatment - the insured person's entitlement to benefits, the legal relationships between the health insurance companies and the service providers and questions of quality assurance. The aim is to achieve transparent, high-quality and needs-based patient-centered preclinical emergency care in accordance with nationally comparable specifications; This also serves the goal of ensuring quality and cost-effectiveness.
According to the Commission's idea, the rescue service should be considered an independent service segment (emergency treatment).
Section 27 Paragraph 1 SGB V should be included. The specific benefit entitlement of the insured should also be regulated in an independent standard - for example a new § 60 SGB V. The Commission also proposes to provide for the following differentiated benefits:
a. Service of the control center (emergency management, comparable to discharge management according to Section 39 Para. 1a SGB V as a control and coordination service). The operational order from the control center replaces the order for patient transport.
b. Emergency care as on-site care, in particular by emergency paramedics and – if necessary – emergency doctors
c. Emergency transport as a transport service that must be viewed separately from care. Transport must be possible not only to a hospital, but also to the health facility most suitable for the individual emergency, for example to the family doctor's practice or a KV emergency service practice.
d. Emergency nursing care, emergency palliative care and psychiatric-psychosocial crisis intervention for complex cases, summarized as special outpatient emergency care (SANV) based on the SAPV.

According to the 9th statement, Section 133 SGB V also needs a fundamental recast with regard to the legal relationships between health insurance companies and service providers (legally regulated contract model with the health insurance companies as contractual partners), especially with regard to financing. Firstly, a conflict resolution mechanism should be established in SGB V; secondly, in the context of paragraphs 135 ff. SGB V, the question of quality assurance, which has not yet been addressed, should be standardized.
In order to promote the quality of the emergency services, the Commission believes that measures to create transparency and quality assurance are necessary, and structural and process quality parameters should also be introduced - a clear indication of the range of tasks to be taken on by health services research. This includes, for example, requirements for minimum staffing levels, qualifications and further qualification measures in the sense of fixed training, further education and further training for emergency service and control center personnel, type and number and standardized equipment of rescue equipment, the implementation of uniform medical and therefore also nationwide comparable requirements as well as participation in registers or the use of special rescue equipment such as intensive care transport vehicles.
The aim should also be to establish an emergency care register in which a core data set (automated transmission of data that is already available digitally, taking data economy into account) from the KV emergency service, rescue service and emergency rooms as well as “integrated emergency centers” is brought together in order to monitor the regional quality of care and also the costs nationwide presented transparently and further developed based on evidence. In the Commission's opinion, the register to be set up should be the starting point for reducing regional differences - as long as these cannot be justified on a regional basis. A starting point could be the AKTIN register20, which has so far been used by emergency departments on a voluntary basis and which would currently primarily serve health care research. <<