The author

Jochen A. Werner is Chairman of the Board of the University Hospital Essen.

(Photo: dpa, Essen University Hospital)

congested emergency rooms, Stop admission in children’s hospitalsthe lack of medicines, the shortage of general practitioners and now also the lack of blood supply: what is it that still works in our health system?

A lot of people have wondered that in recent weeks. I would like to give the thumbs up and say that the current contagion situation, the high rate of sick leave among employees and an unfortunate chain of circumstances in general are the triggers for the disaster mood.

But that would be only half the truth. Rather, we should finally stop talking about repeated crisis scenarios as a temporary ailment of the health system. They are not coincidence, but symptoms of a deep structural crisis in our health system and in society.

What are the reasons for undesirable developments? The number of shortcomings is too vast and the implications too profound for a full analysis here.

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I will limit myself, therefore, to the two most important factors: the impact of demographic change on healthcare, which has been completely underestimated so far, and the digitization offensive that has been missing for decades.

Health care financing is out of control

The nursing shortage, which indeed has long been a shortage of skilled workers in all professional groups, is becoming a limiting factor in healthcare in Germany. Germany. As society ages, not only are more and more people retiring with their experience.

These people also reappear in the health system, but not as nurses or doctors, but as sick people or people in need of care. The growing imbalance between service providers and service recipients will push the health system to its limits.

And not only in medical terms, but also in economic terms, because the financing of health is getting out of control. In 2022, the federal subsidy to the health fund was already almost 30 billion euros. This is almost double what it was in 2019. These ultimately debt-financed expenditures are covering structural problems in the health system that would otherwise affect policyholders in the form of higher health insurance contributions.

Due to demographics that cannot be changed, the second system failure stings even more, namely digitization still fallow. It could be a core solution, a real game changer.

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Instead, for years we have only seen stagnation in relation to grotesque failures, such as the widespread uselessness of the electronic patient record (EHR); the downright bizarre termination of the e-prescribing pilot program over privacy concerns; the still missing use of an electronic identity or the implementation of the law of the hospital future, which is dying in time.

The deep deficits in the health system are based on past omissions and cannot be solved in the short or medium term. They can only be managed in the best possible way. And above all, fast: every day of hesitation exacerbates the problems.

Lauterbach hospital reform falls short in many ways, but it’s a start

The hospital reform initiated by the Federal Minister of Health Lauterbach is by no means a revolution and falls short in many respects. Above all, it avoids the fact that we have excess capacity of hospital beds and clinics in Germany. About 30 percent of clinics could be closed, repurposed or merged without the quality of healthcare suffering as a result.

The specification of content and time objectives is also missing. However: Lauterbach’s reform is based on an accurate analysis, it contains sensible approaches and, above all, it is the first reforming impulse that would have to be taken seriously in what seemed like an eternity.

In one fell swoop, it will not break the vicious circle of the health system or the dominance of particular interests or the associated lack of will to change and the brake on federalism. But hospital reform can and should be the starting signal for a fundamental modernization of the health system, the first step in what is unfortunately still a long road.

In this sense, 2023, the year in which the second half of the legislative period begins, will be the year of the irreversible substantive decision on the question of whether the health system will be capable of ensuring its efficiency and affordability.

Or if we remain unable to act here and at some point look back in amazement at the ruins of a system that once worked, like the railways. armed forcestransport infrastructure and basically also education.
The author:
Jochen A. Werner is Chairman of the Board of the University Hospital Essen.

More: “Hospitals are in an emergency”: the hospital reform should be completed by the summer

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