Overworked staff, too much bureaucracy, and inefficient structures. The situation for healthcare professionals in Germany is tense and will continue to worsen in the coming years. This is according to a report by the German Council of Economic Experts for the Assessment of Developments in Healthcare and Nursing , which was presented to the Federal Minister of Health Prof. Dr. Karl Lauterbach on April 25, 2024, and presented to the public at the Federal Press Conference.
Prof. Dr. Leonie Sundmacher, Head of the Associate Professorship of Health Economics (CHEC), was appointed to the Expert Council on Health and Care of the Federal Ministry of Health on February 1, 2023. The health economist and six other top-class scientists contributed her expertise to the report, which is intended to initiate reforms in the healthcare system.
"We urgently need to tackle structural problems and make better use of the valuable personnel resource. This includes reducing non-essential medical occupancy days, establishing primary care centers, jointly planning outpatient capacities, and making the nursing profession, in particular, more attractive," explains Prof. Sundmacher.
Waste of resources and (no) shortage of skilled workers
"Specialists in the healthcare sector - Sustainable use of a scarce resource" is the working title of the 330-page report. The title has been chosen quite programmatically, as the effects of the acute shortage of skilled workers in the healthcare sector are becoming increasingly apparent. Patients and those in need of care suffer from demanding access to necessary and high-quality care services, as the number of specialists is insufficient. In addition, the care design is often not optimally geared towards the needs of patients, which jeopardizes their safety.
There is criticism of training in particular. The Federal Minister of Health blamed the lack of provision for the tens of thousands of doctors shortage. "We have had around 50,000 too few medical student places over the last ten years." The increasing number of foreign doctors has primarily compensated for the shortage. But now Germany is increasingly competing with other countries, according to Prof. Lauterbach. “This cannot continue.” This seems paradoxical because, unlike other countries, Germany is in the top group regarding the basic quantity of specialists. After all, there are around 1.2 million people in nursing, around 700,000 in senior care, around 700,000 medical assistants, and around 500,000 doctors in Germany.
SVR Chairman Prof. Dr. Michael Hallek, oncologist at the University of Cologne, explains: "In an international comparison, the German healthcare system has a relatively large number of employees about the population. Nevertheless, there are clear supply bottlenecks. This points to structural deficits in the German healthcare system. Against this backdrop, we recommend a package of measures to ensure that the valuable resource of specialists can be deployed in a more targeted manner in the interests of patient welfare in the future."
For example, Germany has too many hospitals that can offer a different quality of care than specialized facilities but tie up a lot of staff with their round-the-clock operations. Patients are too often treated unnecessarily in hospitals and remain there for too long. The fact that many staff are employed part-time is also a problem for the facilities.
Measures for the future
Against this backdrop, the experts' report focuses on the reform of emergency care, in particular through emergency centers and better, less fragmented outpatient care close to home. There is a need for fewer unnecessary emergency interventions, fewer hospital admissions, and a shorter stay for patients in the hospitals.
In addition, nursing professions are to become significantly more attractive by offering better training and career opportunities. The additional skills of nursing staff should also increase their responsibility. If care, therapeutic measures, and prescription of certain medications are bundled together, capacities will be created in other areas. In addition, telemedical care is to be expanded, and jobs and conditions will be significantly improved.
"The turnaround also means that telemedicine must be taken into account in the demand planning of SHI-accredited physicians. We must use the available options to provide patients with the best possible care using existing medical and nursing staff," concludes the health economist Prof. Sundmacher.
To the homepage of the Associate Professorship of Health Economics (CHEC)
To the report and the press release of the German Advisory Council on Health and Care
Kontakt:
Prof. Dr. Leonie Sundmacher
Associate Professorship of Health Economics (CHEC)
Georg-Brauchle Ring 60/62
80992 München
phone: 089 289 24464
e-Mail: leonie.sundmacher(at)tum.de
Text: Bastian Daneyko
Photos: BMG/Rolf Schulten/Federal Press Conference