Improving demand forecasting and putting additional requirements out to tender
Public authorities have only very limited scope to predict where healthcare needs will arise in the future. The current system of coordination between planning authorities and hospitals can also lead to disadvantages for patients if it restricts competition and eliminates alternative options. Healthcare needs can be met more effectively if hospitals are empowered to adapt their services independently to meet those needs. Planning tasks, by contrast, should focus on ensuring comprehensive healthcare provision across the board. Rather than pre-planning the full range of healthcare provision, the federal states should specify minimum care requirements more clearly by setting a guarantee threshold. In the event that this threshold is not met, planning authorities should be given the option to put additional requirements out to tender up to the calculated guarantee threshold.
Reorganise funding, implement guarantee surcharges correctly
Hospitals are currently funded primarily through flat-rate payments per case, which are paid by health insurance funds, and to a lesser extent through investment funds from the federal states. The flat-rate payment system lacks transparency and is not consistently structured. At the same time, it is not possible to provide targeted support to those hospitals that offer the care services required to meet local needs. This is why so-called ‘provision surcharges’ need to be introduced as a new funding instrument. These surcharges should be specifically designed to finance the provision of care to meet local needs and must therefore be adaptable by the federal states to reflect local requirements. By contrast, the flat-rate per-case system should be further developed in future by a scientific advisory board. Overall, this should ensure that funding is allocated in a more targeted manner whilst remaining compatible with competition.
Improving transparency regarding hospital quality
When choosing a hospital, patients are effectively deciding on their preferred standard of care. To ensure that these decisions lead to improved quality, more information on quality should be made available. Health insurance providers should therefore be obliged to advise insured persons on the selection of a hospital. To this end, they could in future analyse their own data more frequently. In addition, quality information is also available from the central quality assurance scheme, in which hospitals are legally required to participate. To date, however, hospitals have had a say – via the Joint Federal Committee – in shaping their own quality control procedures. It is therefore recommended that the Federal Minister for Health also commission independent expert reports on the further development of quality assurance.
Utilising service group concepts in hospital planning
Planning authorities, too, are obliged to carry out their own quality assurance. However, many state authorities lack both the necessary staffing and quality assurance concepts that are compatible with competition. Today, care-level concepts play an important role, but they have the disadvantage of restricting competition on quality. The approach now being applied for the first time in North Rhine-Westphalia – planning based on so-called service groups – would be preferable. When applied appropriately, this approach gives hospitals greater scope to adapt their services to meet demand in a competitive environment.
