The German health system is not in good shape. It is inefficient and, per capita, the most expensive in Europe, says Health Minister Karl Lauterbach of the SPD. He does not want to stir up alarmism, but rather to point out that a “change of times” is urgently needed, Lauterbach said recently at a conference in Rostock.

With “turning point,” Lauterbach is referring to the military turning point that Chancellor Olaf Scholz proclaimed after the complete Russian invasion of Ukraine in 2022. The minister wants similar major upheavals for the health care system as for defense policy.

Lauterbach has presented comprehensive reform plans for this. Around 15 different draft laws are currently being discussed. They are intended to solve the biggest problems: too few doctors, too many empty hospital beds, too much financial pressure on hospitals and slow digitization.

However, the verdict on Lauterbach’s ambitions has so far been mixed: Most doctors’ associations have praised Lauterbach’s plans, while health insurance companies have warned against higher contributions. Dirk Heinrich, an ENT doctor and chairman of the Virchowbund doctors’ association, told DW that the reforms have “both positive and negative aspects.”

Eugen Brysch, chairman of the German Foundation for Patient Protection, sees more shadows than light: “The Federal Minister of Health has many ideas. But it is doubtful whether they are suitable for practical use,” said Brysch in an interview with DW.

New hospital financing

One of Lauterbach’s biggest and most controversial plans was approved by Scholz’s cabinet in mid-May: a hospital reform that the minister describes as a “revolution.”

The starting point: Germany has the highest number of hospital beds per capita in the European Union (7.9 beds per 1,000 inhabitants – EU average: 5.3). Maintaining these beds is expensive. According to Lauterbach, this has led to many hospitals being on the verge of bankruptcy. The result is that patients remain in hospital unnecessarily so that they can charge health insurers more money. This in turn drives up health costs and insurance premiums.

Artificial intelligence (AI) and robots in the operating room
Cost-intensive: Modern methods such as robots in the operating room are expensivePhoto: Mehmed Smajić/DW

The reform will mean that hospitals will no longer be paid per treatment. Instead, clinics will receive so-called flat-rate fees. This means that hospitals will receive a large portion of the money for maintaining staff and equipment or for operating an emergency room, for example.

This is intended to reduce the financial pressure to perform as many operations and treatments as possible, even if a hospital is not sufficiently qualified to do so.

This measure is intended to ensure that patients who require complex treatment are referred to specialists earlier. According to the Ministry of Health, this will reduce healthcare costs in the long term. Patients would have a better chance of recovery and would be less likely to fall victim to medical errors if hospital staff were less rushed and overworked. Lauterbach believes that this reform could save tens of thousands of lives a year.

Secondly, the reform aims to improve the quality of medical care. Germany may have the highest per capita spending on hospitals in Europe, but that does not mean that the care is the best. Therefore, in the future, not every treatment will be possible in every clinic. Stricter requirements will be introduced, for example with regard to the number of specialists. Clinics that do not meet these requirements will no longer receive money for certain procedures.

Too few doctors in rural areas

“Hospital reform is of course right and important,” says Dirk Heinrich from the Virchow Association. “Ultimately, we have too many inpatient treatments. But what is happening now is far too little.” He calls for more treatments to be carried out on an outpatient basis, i.e. without patients having to stay in hospital. The emergency service also needs to be reformed.

Eugen Brysch from the Patient Protection Foundation is also skeptical. “In outpatient medical care, elderly, chronically ill and people in need of care can hardly find a new family doctor,” he says.

Germany is struggling with a shortage of medical practices in rural areas as fewer doctors want to set up practice there. The Ministry of Health wants to address this problem by offering additional funding to clinics in rural areas.

Here, too, Brysch is cautious: “The fact that better earning opportunities are now being created will not, on its own, lead to more doctors in rural regions. After all, other location factors also play a role.”

Artificial intelligence in the emergency room

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One problem was solved with the new reform: the cap on fees for general practitioners. Doctors have long complained about this budget limit – and occasionally even gone on strike – because they were often forced to treat patients free of charge. Lauterbach hopes that the abolition of the upper limit will offer doctors new incentives. Heinrich welcomes this step, but says here too, Lauterbach does not go far enough. “It just stays halfway because the specialists are not being de-budgeted. It is of no use to the patient if they can get an appointment with their general practitioner more easily and then have to wait months for the specialist appointment.”

A multitude of smaller reforms

Some smaller reform plans are less controversial: Lauterbach wants every patient to receive a single digital medical record. This should record the treatments and test results of all the doctors they have seen.

In addition, waiting times in doctors’ offices will be reduced by allowing doctors to conduct consultations online or by telephone and to prescribe medication for chronically ill patients for a whole year. Currently, such patients have to go to the doctor every three months to have their prescriptions renewed.

The new hospital atlas is already onlineIt allows patients to compare hospitals – based on an overview of treatment options, staffing levels, case numbers and the number of complications. But this initiative by the Health Minister has also been criticized. Politicians from opposition parties have already called for the comparison portal to be taken offline immediately because it provides patients with incorrect information. The Health Ministry has now announced that it will continuously update the atlas in light of ongoing criticism.

This article has been adapted from English.