Health Minister Spahn wanted to put a protective shield over the clinics for the fight against the coronavirus. But the rescue package planned so far is not enough.
The suggestion sounded good. “Please postpone operations and interventions that can be planned now,” Federal Health Minister Jens Spahn asked the managing directors of the German hospitals in a letter a week ago. In his “urgent appeal”, as he called it, he also agreed to offset the economic consequences so that no clinic would slide into the loss zone. But the debate over a solution reveals that Spahn lacks the courage to put his words into action. The clinics and the many people who will need help there over the next few weeks and months could suffer.
In the hospitals, they are now clearing departments, reorganizing their teams, and desperately trying to get enough material for treatment. There is a lack of protective equipment, sometimes even material for operations, because their transport is stuck at the borders. There is also a shortage of adequately trained doctors and nurses for the intensive care units. And many clinics are already lacking enough income because they leave beds empty for corona patients. The first houses are working on short-time work because the necessary liquidity is lacking.
There is not much time left. Over the next few weeks, doctors expect a rapidly increasing number of people who are seriously ill from a coronavirus infection. Many clinics are an “absolute battleground” from the perspective of doctors.
Intensive care physicians are afraid of having to decide soon whether to help one patient or rather another with better prospects. They are worried because doctors will soon have to take care of ventilated intensive care patients who only learned how to use the devices in a crash course. They fear that they will fall ill and fail because respiratory masks and disinfection are becoming scarce. The first hospitals in North Rhine-Westphalia are already reporting how the pace of work is soaring that routine is no longer possible because so many sick people have to be cared for at the same time.
Spahn expects a lot from clinics
It would be the right time for the protective shield that Minister of Health Spahn wants to open. An umbrella that secures clinics so that they can concentrate fully on the sick. This weekend, Minister of Health Spahn put together his aid package for the clinics. The first draft law is – and the minister already has to make improvements.
Because the clinics are storming the plan. With good reason: Spahn expects hospitals to do more than they can bear. Because he lacks the courage to make a big hit? Because he does not expose the complex billing systems with which hospitals have been paid up to now, although hardly anyone will soon have time to implement them. But when, if not now, when the country is heading for a fundamental health crisis, would this be the right time?
Spahn wants to provide 3.3 billion euros from the federal budget. Health insurance companies should add 4.5 billion euros. Now there was money for empty beds for the first time, for the higher expenses in care as well, bureaucracy and sanctions would be suspended, Spahn praised his bill in the “Bild am Sonntag”. “With flat-rate payments, we provide the hospitals with the urgently needed liquidity quickly and generously.” But what he delivered is not the big words.
Because there remains bureaucracy, there is a lack of secure cash inflows. Spahn wants to double the number of intensive care beds; after all, around 80 percent of the 28,000 beds available so far are occupied. The clinics were to receive 30,000 euros for each new bed according to Spahn’s bill, which actually costs almost three times as much. Now he adjusts due to the criticism and 50,000 euros are in the room. It is questionable whether that will be enough. The minister did not want to reimburse material costs, although hospitals already have to pay 25 times for respiratory masks on the market. Rehabilitation clinics, which are now being vacated, have not been given any additional money in the design, even though most of their proceeds have been lost.
Doctors are now needed for the sick, not for billing
On top of that, hospitals should continue to have their doctors document the work in detail for later billing of individual services, and the houses should give a precise breakdown of how many nurses worked per patient. Ultimately, it should be checked whether they have to pay back something from the 4.5 billion euros of the health insurance funds.
But who should have the time in the hospitals in the Corona emergency? In good times, detailed documentation of the clinics is important in order not to pay them too much, but also not too little money, and an important control mechanism for the quality of health care. For the controls by the medical service, the processes are central to the fight against fraud, which is also rampant in hospitals. Perhaps some clinics will take advantage of the situation if they now receive money with fewer controls. But the bulk must now be secured first. If everything was survived, the time would have come for major structural changes and an exact calculation of who was wrongly withdrawing the money in the health care system. This task is pending anyway.
If the clinics had guaranteed their previous year’s budget, everyone would be covered
Spahn has given doctors’ offices a simple procedure to help them. In principle, they receive the money of the previous year as soon as they suffer disadvantages from the care of corona patients. It would be an equally practical solution for the clinics that had long been in the negotiations with the Minister of Health. Hospitals that know their budget from the previous year can go to work undisturbed and be sure of their liquidity.
The question will now be whether the minister is now turning around sufficiently or whether Chancellor Angela Merkel is giving a powerful boost in the right direction in the talks that are still being planned. After all, according to their criticism, hospitals are now to receive more money for beds that remain free and a surcharge per patient. Next week there should and must be a law for hospital help. “The hospitals deserve the best possible support during this time,” Spahn wrote on Saturday on the short message service Twitter. “We provide more financial security,” he promised the clinics, “so that those who are there for all of us can take care of the patients with all our might.” This now requires courageous decisions.
You will find all current information and recommendations from the Ministry of Health here.
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