An honest stocktaking, please

Reforms, revolutions and setbacks – February had a lot to offer in terms of healthcare. Above all, however, the past four weeks have shown that the system is groaning and creaking in more and more places. So we need to change something, but in the right places, please. Quo Vadis Digital Health: An honest assessment is needed.

If you haven’t read the Berlin.Table interview with our Federal Minister of Health, Karl Lauterbach: Apparently, 2023 will be the turning point for healthcare in Germany. There is talk of over a dozen new legislative projects, the planned hospital reform is described as a revolution, established doctors are to be protected from the clutches of large investors and, of course, digitization is also high on his agenda, as he elaborates: “In a few weeks, new major laws will be introduced precisely for this purpose. On digitization and especially the Data Use Act. We’ve been working on that for many months, and there’s also provision for the electronic patient file to become everyday for everyone, and as an opt-out variant.” In the meantime, the time has come. Thursday, the first draft of the digital strategy will be presented. We are all excited.

Karl Lauterbach wouldn’t be a real politician, however, if he cleverly skirted the answers to some questions – such as those about the investment requirements of the hospital reform or even about clinic closures. What is also missing is the shortage of skilled workers, or rather the “flight of skilled workers,” as Dr. Albrecht Klöpfer, head of the capital city office of the German Society for Integrated Care in Healthcare, DGIV, so aptly described it in Healthcare & Management magazine. He cites the figure of 25 percent as evidence. That is how many physicians are now considering giving up their profession. Nursing staff leave after an average of eight years, physiotherapists after just seven.

Pension insurance is getting involved

To make matters worse, the German pension insurance is now speaking out. Whereas the “pool doctors” in emergency care were previously considered freelancers, they now classify filling in for colleagues on emergency duty as dependent employment. In other words, the 1,700 pool physicians working in Baden-Württemberg alone would have to take up permanent positions. According to the local Association of Statutory Health Insurance Physicians, KVBW, this would threaten the collapse of the on-call service. 1.3 million patients would be affected. KVBW head Karsten Braun told the Stuttgarter Nachrichten: “Only with the pool doctor system do we manage to keep many urgently needed doctors in regular care.

If one now compares the reform motivation of the Federal Minister of Health with the rest of the news, one cannot help but notice a certain discrepancy. What’s more, with a little distance it becomes clear that reforms are urgently needed, but above all that something must be changed in processes and structures to prevent the system from collapsing. Those who think within the existing structures and “only” want to polish them up with a little fresh paint will not achieve anything.

Stocktaking required

We humans are creatures of habit, and once we have made ourselves comfortable, change is very difficult. Nowhere is this more evident than in healthcare. Here, there are many small territories that no one really wants to give up. That’s why true transformation is so rare and why there is still too much sectoral thinking – the KHZG as well as the hospital reform underline this. Now I can literally hear the objection: But we have to start somewhere. Yes, absolutely right. We just can’t stop when things get uncomfortable.

If the issues and headlines of the past month have shown one thing, it’s that the system is not only groaning and creaking ever more clearly, but also in more and more places. Conversely, this means that we need to provide relief. Digitization is definitely a viable and important approach here. However, this is only possible if work is done on the structures. An analog process that is digitized is not automatically better or more efficient – precisely because digitization is not an end in itself. So what we really need is a kind of inventory, a stocktaking of what works well, but even more importantly a meticulous analysis of the neuralgic points.

And then?

Because only with this inventory can real changes be initiated, processes rethought and bridges built wherever they are needed from the point of view of patients but also professionals. First and foremost, of course, this means breaking down silos just as much as it means breaking down barriers. Interoperability will become one of the really important game changers for true transformation.

In this context, however, breaking down barriers also means that reforms must be designed across sectors – or at least build on each other. After the hospital reform, we therefore need a healthcare reform, a remuneration reform and perhaps also an employment reform for the German pension fund. I think the point becomes clear: We need to think big, we need to think anew, and we need to think boldly. But above all, we also need to talk about the issues that no one really wants to talk about at the moment. In some places, it may hurt when the band-aid is removed – but only for a brief moment. After all, following the hospital reform, the digital reform is now also becoming concrete. Whether it will be possible to overcome the first obstacles here should become clear as early as Thursday. Lauterbach has been rather pragmatic about the electronic patient file. We can look forward to seeing what the Federal Data Protection Commissioner has to say about the draft reform. After all, he did it “again” with the ePA.