Government commission presents reform proposals for pediatric medicine and treatment of mental illnesses
02.10.2023 12:46
The government commission for modern and needs-based hospital care calls for stable financing of child and adolescent medicine through a surcharge on reserve funding, the introduction of pediatric institute outpatient clinics and more flexible treatment of mental illnesses by hospitals in two new statements. In it, the government commission makes proposals for the short, medium and long-term reform of conservative and surgical pediatric and adolescent medicine. The commission is also addressing the question of how care and access to psychiatry, psychosomatic care and child and adolescent psychiatry can be improved.
Federal Minister of Health Prof. Karl Lauterbach:
“Children and young people who become seriously ill need quick help. And sometimes not only the severity of the clinical picture, but also the distance to the practice requires treatment in a hospital. For this we need clever concepts and good cooperation between practicing specialists and hospitals - not sticking to rigid sector boundaries. The government commission’s proposals are a good basis for this.”
Prof. Tom Bschor, head of the government commission for modern and needs-based hospital care:
“Pediatrics must offer all diagnostics and therapies for children and adolescents that are spread across a wide range of medical disciplines for adults. It therefore needs a continuation of the financial surcharge granted for 2023 and 2024. The institute outpatient clinics, which have proven themselves in psychiatry, are an excellent instrument for flexible treatment of children and adolescents in hospitals and for closing gaps in outpatient care. Psychiatry, child and adolescent psychiatry and psychosomatics are exemplary in terms of modern hospital treatment, for example with regard to the possibility of full-time inpatient, day clinic, outpatient and outpatient treatment, population-related planning or decades of experience with minimum staffing levels. It is now important to take the next step and overcome the separation of areas within a hospital department.”
The recommendations in detail
Paediatrics
- Binding quality standards should be developed for surgical and conservative pediatric and adolescent medicine.
- In accordance with the recommendations of the government commission in the third statement, the future reserve budget for the pediatric and pediatric surgery service groups should be permanently increased by a surcharge of up to 20 % of the previous aDRG revenue volumes of the specialist departments of surgical and conservative pediatric and adolescent medicine. For this purpose, the creation of a special fund is recommended.
- Similar to what has been proven in child psychiatric care, it should also be possible to set up institute outpatient clinics for somatic child and adolescent medicine that participate in outpatient statutory health care. Children who are dependent on treatment in hospital because of the nature, severity, rarity or duration of their illness or because they are too far away from suitable established specialists for children and adolescents should be able to receive outpatient treatment there after being referred by a contracted doctor .
- In order to relieve the burden on clinics and departments of pediatric and adolescent medicine in the short term, the primary incorrect occupancy check for day hospital treatments and the secondary incorrect occupancy check should be suspended if the upper limit of stay is exceeded or the lower limit of stay is not reached.
Treatment of mental illnesses
- Psychiatric, psychosomatic and child and adolescent psychiatric care should be available at all level In to III(U) hospitals.
- Level II hospitals should cooperate with relevant clinics or departments, particularly in the area of geriatric psychiatric care.
- Due to large regional differences, child and adolescent psychiatry should be expanded, especially in underserved regions, and should also ensure outpatient care there if the gap cannot be closed by practicing doctors.
- In order to ensure a smooth transition for adolescents from child and adolescent to adult psychiatric care, close cooperation between both disciplines must be envisaged. A closer integration of somatic and psychiatric care offerings is also required in the area of child and adolescent medicine.
- In comparison to somatic medicine, the requirements for sufficient staffing levels for the treatment of mental illnesses require a lot of documentation and are subject to sanctions, which is why they should be adapted to the level for proving the minimum nursing staff limits in somatic medicine.
- Hospital treatment for mental illness should be able to be carried out more flexibly in terms of the setting, which means that psychiatric beds should generally also be used in day clinics and the separate billing channels should be overcome in the future.
- For the model project of a quarterly flat rate (§ 64b SGB V), which has been successfully tested many times in psychiatry, there will in future be an obligation for all health insurance companies to conclude a contract under certain circumstances (compulsory contracting). A nationwide framework concept for budget determination and financing should avoid years of individual regional negotiations. In the future, the KV side will also be included as a contractual partner.
- Remuneration for psychiatric and psychosomatic services was reformed in 2018 with the system based on daily remuneration rates (PEPP). This system also includes the holding costs, which is why this form of remuneration should be maintained and its effects monitored.
The recommendations in full can be found at: