How much do hospital beds cost

The federal government pays 11.5 billion euros : Where does the money go for empty hospital beds?

There was criticism at an early stage: When the federal government, health insurance associations and clinics agreed in the second half of March to make the hospitals strong for coping with the expected wave of corona patients through additional fees and a flat fee for each bed kept free, resistance arose.

The regulation was too general, it said. The 560 euros agreed under pressure from the German Hospital Association (DKG) for each bed kept free compared to the occupancy figures of 2019 will lead to expensive deadweight effects, warned the Greens. From July 1, the flat rate will now be staggered - depending on their case mix, the clinics have since received between 360 and 760 euros per bed.

The bed premium should initially cost around 2.5 billion euros. In fact, the Federal Social Security Office had already transferred 5.33 billion euros to the federal states responsible for distribution by June 15. In addition, there are 520 million euros for additional intensive care beds. By the end of September, when the scheme expires, it could turn into 11.5 billion euros. Reason enough to take a close look at where the money ended up, you would think.

At the moment, however, it doesn't look like it will come to that. In most of the federal states no evaluation is planned. There are also no plans to hand over the data to the regional health insurance associations responsible for clinic remuneration. The agreement concluded with the National Association of Statutory Health Insurance Funds (GKV) only stipulates that the federal states may, but do not have to, release the data.

Countries cannot quantify how funds are distributed

When asked what North Rhine-Westphalia knew about the use of the 1.3 billion euros previously distributed to the state's clinics, a spokesman for Social Affairs Minister Karl-Josef Laumann (CDU) said: "We have no knowledge about this." The ministry only makes sure that the guidelines are adhered to. "A differentiated view of the payee is not yet planned."

There are also no plans to forward the data to the health insurance associations. The same in Bavaria. There, the state government checks whether publication is even possible under data protection law. Thuringia alone has been handling the data transparently so far, they say.

An absurdity, thinks Sigrid König, board member of the BKK regional association of Bavaria. “We have proven that the German healthcare system can adapt capacities flexibly and at short notice,” she says. A watering can is used to help. "There is a lack of transparency, which has to be established as quickly as possible." Otherwise there is a risk that "the Corona aid will cement existing structural deficits," she criticizes.

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Structural deficits are particularly large in Bavaria and North Rhine-Westphalia, because nowhere in Germany is the hospital landscape so rugged and dominated by small hospitals as in these federal states. Dirk Janssen, deputy chairman of the BKK-Verband Nord-West, has the same criticism: “When it came to the decision to offer a flat fee for all hospitals, politicians had the terrible images from Italy in mind,” he says. "But now it is becoming apparent that such strong false incentives are being set."

Psychiatric facilities are just as favored as rehabilitation facilities or rural hospitals, "which are not or not at all suitable for the treatment of seriously ill Covid-19 patients".

For some houses it was cheaper not to provide any services

This has meant that for a number of economically weak hospitals it was cheaper not to provide any services at all than to care for patients. The subsidy is now also being used for beds that have remained empty because patients have avoided or postponed treatments on their own initiative.

"With a view to the necessary form of the hospital structure, it would therefore be good to examine the extent to which the flat rates have actually served their purpose of providing treatment capacities for corona patients," says Janssen.

Actually, this is the job of the state governments, he says. "What is definitely not possible is that the state governments on the one hand forego such an evaluation, but at the same time are not prepared to pass the data on to us so that we can do this job."

Janssen, like König, praises the fact that small clinics are now receiving less money. “This is especially good for the patients. Because we know that a number of corona patients have ended up in small hospitals whose medical staff do not have the expertise to provide intensive care and ventilation for seriously ill patients. ”This must also be dealt with with a view to a possible second wave.

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In Janssen's view, a consequence of the current experience must be to align hospital planning in such a way that sufficient capacities are available in concentrated form in high-quality care hospitals or in special clinics. An evaluation of the “subsidy program for empty beds” could help, says Reinhard Brücker, head of BKK Viaktiv. “We mustn't shy away from making the deadweight effects public. When so much government money is being moved, it must also be checked what it was used for in the end, ”he says.

Even a house that is about to be closed may receive money

Brücker admits that the flat rate for the Geriatric Hütten-Hospital in Dortmund, which is operated by Viaktiv, has been reduced to 360 euros from July onwards. But things get really adventurous when the "state dough for Corona means that a house like the St. Josef Hospital in Bochum-Linden operated by Helios gets money for empty beds".

It was decided in February to close the general hospital at the end of September. "As a result, there has already been a substantial reduction in staff."

In the meantime, the opposition in the Bundestag has also taken the problem into consideration. "The secrecy is incomprehensible," says the health policy spokeswoman for the Green parliamentary group in the Bundestag, Maria Klein-Schmeink. If one wants to evaluate the effects of these regulations, one must also know how the payments affect the respective hospitals. "Jens Spahn has to take legal action here and oblige the federal states to disclose these figures."

The Greens now want to increase the pressure with a written question to Health Minister Jens Spahn (CDU). It is twofold and reads: “Does the Federal Government intend a statutory obligation to disclose the hospital-specific compensation payments? And if not, for what reasons does the Federal Government consider such a transparency regulation unnecessary? "

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