For a Turning Point in the Health Care System

People who are admitted to hospital today are sometimes treated as inpatients, even though this is not absolutely necessary because hospitals can hardly offer any outpatient services due to the current regulations, and there is often a lack of services outside of hospitals. This causes additional costs and is inefficient. Another reason: there is an increasing shortage of specialists, which is why this strict separation is becoming problematic, for example in outpatient emergency care, which often has to be provided by hospitals.

That sounds a bit dramatic, but many young colleagues experience entrepreneurial responsibility and bureaucracy as a huge burden. They primarily want to help people, not manage documents and fend off recourse claims. More and more doctors are even giving up their practices because they see hardly any advantages in doing so. Today, an employed relationship is more attractive for many.

We urgently need to think and act across sectors. The new federal government must finally abolish the rigid separation between outpatient and inpatient care and create a joint budget for both areas. This is the only way to reduce disincentives and make the healthcare system more efficient and fairer. In my opinion, there is no way around medical care centers (MVZ). The new federal government must strengthen central points of contact for primary care. Integrated planning would therefore make sense, in which inpatient and outpatient care structures are brought together.

The patient would first come to the hospital for emergency care, be treated there immediately and then receive further outpatient care. In my many years of hospital experience, this is always in line with patients' wishes.

It is well known that treatment in a specialized cancer center significantly extends life expectancy. Nevertheless, the initial diagnosis could take place in a clinic close to home. The precise planning of the therapy would then take place in a specialized center , for example at the Robert Bosch Hospital in Stuttgart - possibly also remotely via telemedicine. Further care could again be provided on an outpatient basis with digital support. This would make it possible to guarantee optimal treatment for all patients. Provided, of course, that the various entities communicate smoothly with each other.

More than necessary progress! Also with regard to unnecessary costs. Today, expensive and nonsensical duplicate examinations are the rule - also due to the separation of inpatient and outpatient care. It would be a huge step forward - for those providing treatment, but above all for patients - if the best possible level of information were ensured for everyone involved.

Primary care is under enormous pressure today, as many doctors' posts are already unfilled. At the same time, demand is increasing, particularly in the area of prevention. An expansion of primary care centers could make a big difference here. At the Bosch Health Campus, we have introduced the PORT concept, so-called patient-oriented centers for primary and long-term care, with which we have had very good experiences. The same applies to community health nurses, academically trained nursing staff who also work in the areas of prevention, health management and socio-medical care.  However, this also requires a new discussion about the role of nurses. Currently, nurses are only allowed to act on the instructions of a doctor. One concrete example, however, would be the treatment of simple illnesses such as urinary tract infections in care homes for the elderly. A well-trained nurse could easily make diagnoses, carry out laboratory tests and possibly even initiate antibiotic therapy, especially in combination with telemedical support from a doctor. As you can see: Seamless communication is absolutely essential in all of this. The electronic patient record could ensure this. Further possibilities lie in the management of chronic diseases such as diabetes or high blood pressure, including preventive measures.

Prevention does not yet play the role it should in this country. Effective prevention could delay or even prevent chronic diseases, which could save considerable healthcare costs in the long term. This would be urgently needed because, on the other hand, it is also clear that although treatments are becoming increasingly successful, they are also often more expensive - if you think of personalized cancer therapies, for example. Of course, it is absolutely indisputable that all patients should be given the best possible treatment. For us in Germany, calculating "whether it's worth it" seems immoral - and I think rightly so. But it is also clear that the costs of the healthcare system must not be allowed to gallop away. That's why prevention is so important. Prevention must finally become a political priority - the new federal government should consistently anchor health promotion in schools, companies and everyday life. This includes healthier lifestyles such as a balanced diet, exercise and refraining from smoking or excessive alcohol consumption. Doctors, but also the academically trained nursing staff just mentioned, must place even greater emphasis on this in their contact with patients in future.

Society will find it increasingly difficult to finance rising healthcare costs. Similar to the CO₂ levy for climate change, the polluter pays principle could be applied here: Those who consciously take risks, for example by smoking, could be made to contribute via higher taxes. This approach seems socially acceptable to me, especially as it is already established in other areas.

I'll start with a worst-case scenario: then we will develop in the direction of two-tier medicine, as can be seen in the USA, with poorer care for the chronically ill and a high dependency of the quality of care on income. That cannot be our goal. In the best-case scenario - and I am firmly convinced that this is achievable - we will succeed in creating a more effective and quality-assured system with the resources available. Germany is a leader in terms of treatment quality and medical research. We need to ensure that what we have here at the highest level is future-proof and continues to be accessible to all patients. To do this, we need to tackle the funding and the fundamental structures. A big task, but a feasible one. If we then give greater priority to prevention and health maintenance, we will have turned the corner.