When it’s all over, no “usual procedure”. This is a warning from four important health professionals for the post-coronary crisis. In Berlin, Boris Augurzky, Reinhard Busse, Ferdinand Gerlach and Gabriele Meyer presented joint recommendations for a new system setup in Berlin. As a lesson to be learned from a pandemic as soon as there is more air again.
In short, your contribution, commissioned by the Barmer Institute for Health System Research (bifg), the Bertelsmann Foundation and the Robert Bosch Foundation, leads to seven basic requirements: strengthening health authorities, better interconnection of GPs, more specialized hospitals, more integrated primary care centers, cross-sectoral remuneration models, more skills for nurses. And a much more consistent use of the vast possibilities of digitization.
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Let’s start with the second: “Misunderstood data protection must not protect people’s actions and not cost human lives,” the article makes it clear. It would be “negligent and ethically questionable” not to use existing health data, emphasizes Ferdinand Gerlach, Chairman of the Expert Council for the Evaluation of Developments in the Health Care System. The chances of protecting life and health far outweigh the risks of the widely feared misuse of data, he explains. Unfortunately, Germany has been the strictest in an international comparison.
In the corona crisis, digital applications such as the DIVI intensive register or the Demis and Sormas intelligence and information systems for the public health service (ÖGD) provided “a new impetus for the previously slow process of digitizing the German healthcare system,” the authors write. This needs to be strengthened, because in this way there is transparency regarding the spread of disease and the use of capacity. This in turn allows for better “tuning” of health care. As a concrete example, researchers cite a combination of evidence-based initial assessment of the disease, as it is already used nationwide by 116117 control centers with real-time web-based systems for capacity availability. And comprehensive electronic patient documentation must also be available as soon as possible, as it has the “potential to significantly improve collaboration between providers”.
Anchoring “public health” also in medical studies
When it comes to the necessary links with science and doctors, health authorities must also be considered first, experts insist. To do this, however, the ÖGD must first be massively upgraded, requires Reinhard Busse, Professor of Health Management at the Technical University of Berlin. Not only in times of crisis, “many more employees are needed in the offices”. For example, Busse demands that the number of qualified public health specialists in the offices be at least doubled. With currently almost 400, or only one per medical department, you really don’t have to worry about making a “head of water”.
It is also important to embed a “public health perspective” in medical studies, Gerlach added. Potential doctors could also complete a practical year in healthcare. But like many before him, the scientist complained that the ÖGD was still a “terribly bad digital device” and that too little had happened in the last few decades. But the expert left open whether it would help if there were regional health offices again, or even a federal health office.
No treatment of the patient if the hospital equipment is insufficient
Then the big topic of hospitals. The pandemic confirmed “the need for reform towards greater centralization, cooperation and specialization,” the expert said. In short: “Proximity is not the decisive factor for good treatment results, but the equipment of hospital places”. This applies not only to patients with Covid-19, but also to the treatment of heart attack, stroke or cancer.
In order to finally make progress here, experts are calling for fundamental structural reforms. In the future, hospitals will only compete for patients if they are able to provide them with “adequate staffing and technical care”. Specifically, this would mean, for example: Homes without a stroke will no longer be able to charge patients with a stroke, and clinics without a cardiac catheter laboratory will no longer be able to charge patients for a heart attack. Hospital expert Boris Augurzky of the RWI Leibniz Institute for Economic Research in Essen admits that journeys to special suppliers would be longer. Which is quite reasonable for higher quality with the current density of hospitals.
General practitioners, therapists and nursing services under one roof
But what to do with smaller clinics that no community wants to give away or even want to bleed? Researchers say that for such houses, especially in rural areas, there is the prospect of integrated supply centers. They could play an important role in a team with GPs, therapists, rehabilitation services, care services and homes. A good and, if possible, telemedicine-supported connection to a standard or maximum provider in the middle of the region is always necessary.
The big advantage of integrated care centers is the avoidance of expensive inpatient services, says Augurzky. Then you would be responsible for small emergencies during the day, but also for the “follow-up” of serious hospital cases, which has so far been often overlooked. Then, however, it would be necessary to think about a new type of financing, said an expert from the clinic – from purely quantitative remuneration through a flat rate per case, to a higher remuneration for reserved capacities. That, Augurzky added, might also remove the economic incentive for basic providers to do things medically, which they should rather leave to special providers. “
Outpatient care must generally take place more in the centers than in the individual practices, stressed the health management expert Busse. For patients, this would not only have the advantage of a professional exchange between doctors, but also a significantly longer opening hours. What Health Minister Jens Spahn forced to extend consultation hours through the Appointment Act is not enough for good outpatient care.
More skills for nurses
Due to the experience of Corona, attention is also focused on care. People in need of care did not appear in the pandemic plans, but as particularly vulnerable groups, they were the main victims of the corona crisis. Social participation and quality of life are “unrivaled goals of long-term care, even in pandemic conditions that need to be reconciled with protection against infection,” the paper said. The aim is “to develop a comprehensive strategy that will apply across regions and national borders and that will also include crisis intervention and nursing emergency services teams and the strong integration of MDK and home surveillance”.
In addition, there would be a necessary transfer of medicines to carers, who, after the experience of the pandemic, “must now finally become an alternative to regular expanded awareness of skills”. Until now, only trained doctors have been allowed to work invasively, but not by nursing staff. The corresponding law for the transfer of medicinal competencies has existed since 2008, emphasizes Gabriele Meyer, a nurse in nursing at Martin Luther University in Halle-Wittenberg. Unfortunately, because doctors were reluctant to do so, it was not followed up. In reality, however, it is “widely demonstrated” that in primary care, “at least equivalent care for nursing staff with advanced skills” is possible. The advantage would be fewer emergency hospitalizations and also better care for the elderly or chronically ill in rural areas with a shortage of doctors.
According to experts, a uniform law on health professions would be necessary as a basis for variously assigned tasks and areas of activity. “This could also provide for the independent provision of regulated remuneration services and regulate cooperation between nursing professionals and other health professions (including the Liability Act),” said her mandate to the Minister of Health.