Dr. Dominik von Stillfried comments on the proposals for a fundamental reform of hospital remuneration
08.12.2022 10:41
The “Government Commission for Modern and Needs-Based Hospital Care”, presented by Federal Health Minister Lauterbach in May 2022, presented its third statement and recommendation on December 6th. This time the focus is on proposals for a fundamental reform of hospital remuneration. The chairman of the board of the Central Institute for Statutory Health Insurance (Zi), Dr. Dominik von Stillfried, position.
“The reform proposal contains good elements of a future financing structure. It is an interesting contribution to the debate, but it was obviously mainly drawn up from the environment of large hospitals, which have a high level of vested interest in maintaining functioning hospital structures - especially in the higher levels of inpatient care. It is also obvious that a crucial component is completely missing: a fully developed structural concept!
A structural concept on the basis of which it can be derived how many hospitals with which structure are needed to care for the population. Instead of remuneration depending on the number of cases, provisional services will be remunerated in the future. However, the mechanism for this is unclear in key respects, as the reserve funding shares are to be calculated based on existing caseload-related budgets. However, without a clear reference to the population, in which funds for reserve financing are only allocated once per citizen based on needs criteria, the case number-related hamster wheel can hardly be stopped. The problem is exacerbated by the fact that the approach is apparently to be budget-neutral on a country-by-country basis. On the one hand, this means that regions such as Saxony with low case numbers will also receive less reserve funding than Thuringia due to more advanced hospital structures.
On the other hand, it means that clinics that are viewed as necessary but have a low level of service and few patients continue to be financed based on this feature alone (security surcharges). There is then no money to finance more supply-relevant structures. In short: If no hospital voluntarily withdraws from medical care, the result is unlikely to change.
Except that payment transactions have become more complex and bureaucracy has become even more excessive. With its reform proposal, the Commission would also like to interlink the sectors more closely and introduce a separate care level Ii (integrated outpatient/inpatient hospitals). General and specialized outpatient medical services are to be provided close to home, as well as acute care beds are to be available. In these, patients should be able to be monitored and cared for as inpatients. In contrast to all other levels, the remuneration of Level II hospitals should be based on appropriately calculated, degressive daily flat rates. The remuneration for medical services for doctors employed at the hospital should be through increased daily flat rates and for contract doctors according to the uniform assessment standard.
We will be watching this project closely and hope that the legislature does not forget that with the introduction of Section 115f SGB V, it is ensuring that the differences in remuneration between services provided by statutory health insurance providers and services provided at hospitals are finally eliminated. If different prices were to be paid again for the same services for care level Ii services, this would be a major step backwards,” says von Stillfried.