PwC calls for an offensive against the gradual loss of quality in the German healthcare system

16.01.2019 11:46

How do Germans rate their medical care? Where do you see weak points? The auditing and consulting firm PricewaterhouseCoopers (PwC) says it has surveyed around 15,000 people in Germany over the past five years on these and other key areas. Michael Burkhart, head of the healthcare sector at PwC, has summarized the results in a study - and has derived recommendations for action for a structural new start in the healthcare system.

“We see political reform attempts in the healthcare system about every two years,” says Michael Burkhart. “Important fundamental questions often remain untouched.” In order to ensure the high medical quality of the healthcare system for the future, he suggests improvements in five subject areas.

The dual financing of hospitals by health insurance companies and federal states regularly leads to conflicts about who has to finance certain services or investments. In the end, often no one pays and important changes do not occur.

PwC health expert Burkhart therefore suggests monistic hospital financing by health insurance companies, as already exists in geriatric care, rehabilitation and diagnostics. The overall costs remain the same, but the clear responsibility makes important decisions possible. The only exception: University clinics and academic teaching hospitals should continue to be operated from tax-financed state budgets.

Quality incentive through per-inhabitant financing

Michael Burkhart also suggests hospital financing per inhabitant: A hospital is responsible for the citizens in its area and receives a budget for their treatment. The fewer people need to be treated, the more profitable the individual clinic is. “This would reward clinics that focus more on prevention than on treatment of diseases,” says Burkhart. If patients preferred to go to a hospital other than the one actually responsible for them, the “home hospital” would have to pay the treating hospital a certain amount. “This gives every clinic an incentive to be the best in its area of responsibility,” says Burkhart.

Systemically relevant and market-based clinics

Which clinics are “systemically relevant”, i.e. provide necessary health services at an acceptable distance for the population, and which are in competition with other providers in their region? The distinction is important to PwC expert Michael Burkhart because: For “systemically important” clinics, loss compensation would be possible despite monistic financing, which would prevent closure without the consent of the respective federal state. And: “The losses of institutions operating in a market economy will then no longer be able to be offset with public money.”

Greater incentives for rural doctors

Rural regions are structurally underserved medically. Politicians are counteracting this with the so-called rural doctor quota, and federal states such as North Rhine-Westphalia also want to attract more doctors to rural regions with the “Master Plan for Medical Studies 2020”. The biggest obstacles for doctors in rural areas are the lack of family and leisure-friendly working hours and the entrepreneurial risk. “Centres in which doctors who want to start a business come together could provide a solution here,” says Burkart. Consideration should be given to support programs for rural doctors starting up their own businesses, as well as low-cost or interest-free start-up loans.

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