Lack of doctors and financial crisis in hospitals, DW: How will Germany's sick health system recover?

Lack of doctors, financial crisis in hospitals, poor digitalization standards. Germany's Health Minister Lauterbach aims for a wide-ranging reform of the health system, but faces criticism. When the German Minister of Health, Karl Lauterbach talks about the reform, words like revolution are heard, according to him, the new reform is nothing less than a revolution. At an annual conference of doctors in early May, Germany's health minister called the reform plans he had been working on for two years a "Zeitenwende" - a turning point - in German health care - an allusion to the military turn he made learned Chancellor Olaf Scholz after the Russian aggression against Ukraine in February 2022.

Fear of increased health insurance contributions

About 15 different bills are at a "critical stage," Lauterbach told doctors, all part of a larger effort to tackle a range of problems facing Germany's health system — including: Too few doctors, too many beds empty hospital beds, high financial pressure on hospitals and poor digitization standards.

But opinions on these plans are divided: doctors' associations have praised Lauterbach's plans, while health insurers have warned that it could lead to even higher contributions. Dirk Heinrich, specialist doctor and chairman of the Virchowbund doctors' association, told DW that the reforms are "light and dark". Eugen Brysch, chairman of the German Patient Protection Organization, Deutsche Stiftung Patientenschutz, criticized Lauterbach. "The Federal Minister of Health has many ideas. But it is doubtful whether they are practical," he told DW.

New payment method for hospitals

However, one of Lauterbach's biggest and most controversial plans was approved by Olaf Scholz's government cabinet a few days ago - a hospital reform that will change the way German hospitals are financed and set new healthcare standards.

Germany has the highest number of hospital beds per capita in the European Union (7.9 beds per 1,000 inhabitants - the EU average is 5.3), but maintaining them is expensive. According to Lauterbach, this brought many hospitals to the brink of bankruptcy. The result is that many patients stay in the hospital unnecessarily, so that hospitals can extract additional money from health insurers - which in turn increases the entire country's health costs and insurance contributions.

The new reform envisages that hospitals will no longer be paid for treatment – ​​instead, they will have a guaranteed income for providing certain services. The hope is that this will ease the financial pressure on hospitals that perform as many operations and treatments as possible, even if they are not qualified to perform them.

The reform is supposed to ensure that patients who need complex treatments are referred earlier to specialists. This, according to the Ministry of Health, will reduce health costs in the long run, as patients have a better chance of being cured and are less likely to fall victim to errors. Lauterbach expects this reform to save tens of thousands of lives a year.

A large number of hospitals

"Hospital reform is right and important," Heinrich told DW. "We have many hospitals, but what is happening now is very little. Reforming hospitals without a comprehensive reform of ambulatory treatment and without reforming the emergency system will not bring any change."

Even Eugen Brysch is skeptical. "In the field of ambulatory medical care, the elderly, the chronically ill and the dependent on health care will find it almost impossible to find a new doctor," Brysch points out.

Another problem: Germany struggles with a shortage of doctors in rural areas, as not many doctors want to live in these areas. The Ministry of Health wants to solve this problem by offering clinics in rural areas additional money. But Eugen Brysch thinks, that "the fact that better earning opportunities are now being created will not automatically lead to more doctors in rural areas. After all, other factors also play a role."

At least one issue was resolved with the recent reforms: the payment cap for GPs. Doctors have long complained about this budget cap - and have occasionally gone on strike over it, because it often forces them to treat patients for free. This change, Lauterbach hopes, will give doctors more incentives to take on more patients. Dirk Heinrich from the doctors' association welcomed the reform, but points out that it does not go far enough. "It stops halfway, because the budgets remain in place for specialist doctors", he says. "It doesn't bring anything to a patient if he gets an appointment with the family doctor sooner, but then has to wait months for a specialist."

Some smaller reforms are less controversial: Eg. German Health Minister Karl Lauterbach wants every patient to have a single digital medical record that shows the treatments and test results from all the doctors who treated him. There are also plans to reduce waiting times at clinics by allowing doctors to carry out consultations online or over the phone and provide a year's worth of medication to people with chronic conditions. Until now, such patients had to see their doctor every three months to renew their prescriptions.

Also, the hospital atlas is now available online. It enables patients to compare hospitals using an overview of treatment options, numbers of cases treated and number of complications, as well as information on the qualifications of hospital staff./DW