HHE HOPE 2019 - Page 18

GERMANY Mr George Baum HOPE Governor, German Hospital Federation Could you describe the last hospital and/ or healthcare reforms implemented in your country in the past 5 years? In the last 5 years, political priorities have focussed on the continuous development of quality assurance and of the reimbursement systems for healthcare providers. Additionally, a great importance has been given to measures to face the challenge of health workforce shortage. In 2015, the so-called Hospital Structures Act (Krankenhausstruktur-Gesetz) enforced quality assurance in hospitals; improved financing of nurses and strengthened patient safety as regard nosocomial infections by fostering a hygiene support programme. This act entered into force on 1 January 2016 and included the following key aspects: • Establishing a job promotion programme for nurses for the years 2016–2018 with a total volume of 660 million Euros; • Transforming a former extra-fee to safeguard structures for healthcare provision (Versorgungszuschlag) into an extra-fee for care (Pflegezuschlag) with an overall volume of 500 million Euros; • Introducing binding quality indicators for hospital planning; • Developing further initiatives on quality such as patient friendly quality reports, quality contracts as well as quality-associated extra-fees and deductions; • Establishing funds for the improvement of healthcare-structures with a volume of 500 million Euros; • Definition of minimum standards for hospitals for the provision of emergency care. The training of nurses has been subject of reform with the 2015 Nursing Professions Reform Act (Pflegeberufereformgesetz). Training for nurses, paediatric nurses and long-term care nurses have been merged into a unique programme. With a law on the continuous development of provision and reimbursement of psychiatric and psychosomatic care in the year 2016, a services- oriented financing for hospitals has been introduced. Transparency has been enhanced and a better coordination of inpatient and ambulant services enabled. In May 2018 the most important hospital act in the running legislative period for hospitals has been forecasted. With the Care Personnel Strengthening Act (Pflegepersonalstärkungsgesetz), the general status of nursing and long-term care shall be improved. It is focussed on the full reimbursement of labour costs for care personnel and its extraction of the DRG-system starting with the year 2020. Additionally, partners of the self-governance system (health insurances and services providers) have been mandated to extend the already existing minimum levels for care personnel to further departments in the hospitals. This law came into force at 1 January 2019. GERMANY Total current health expenditure as % of Gross Domestic Product (GDP) General government/compulsory current health expenditure as % of total current health expenditure Hospital current health expenditure, as % of total current health expenditure Household out-of-pocket health expenditure as % of total current health expenditure All hospital beds per 100,000 inhabitants Acute care hospital beds per 100,000 inhabitants Acute care admissions/discharges per 100 inhabitants Average length of stay for acute care hospitals (bed-days) Practising physicians per 100,000 inhabitants Practising nurses per 100,000 inhabitants 18 HHE 2019 | hospitalhealthcare.com 2002 2008 2016 10.1% 10.2% 11.1% 77.8% 75.3% 84.6% 29.6% 28.8% 29.1% 12.4% 14.0% 12.4% 887.0 821.0 806.0 663.0 613.0 606.0 20.2 21.2 23.7 9.6 8.3 7.5 332.0 354.0 419.0 1018.0 1113.0 1285.0