Challenges in the hospital sector

Nhe tensions in which hospital management finds itself are not just a result of competing for patients, specialists and flat rates. In addition, there are regulatory influences such as investments in buildings, amendments to labor laws and the demand for entrepreneurial action.

Performance funding
The partially revised KVG introduced the flat rate per case. The flat rate per case now finances the services provided by the hospital and no longer the operation itself. The costs of facility use and the further training of non-university staff were transferred to the care of the hospitals and are part of the flat rates per case. In the discussion about appropriate tariffs, hospitals must meet the controlling requirements of the federal government and self-regulatory institutions, i.e. contribute to better comparability, for example through standardized accounting. The advantage lies in the increased transparency, the disadvantage in the increased accounting and training costs and the specialized audit.

Wooing for patients and professionals
With the free choice of hospital, a courting of patients began. Privately and semi-privately insured patients, who are also courted by private hospitals, are economically indispensable. With offers of the most modern infrastructure and exclusive hotels, public hospitals also have to stay on the ball. Frequent investments are the result, including in progressive buildings and spacious patient rooms. The strict building regulations for hospitals lead to high costs. These include, for example, requirements for heated helicopter landing pads or separate sewage systems due to high levels of medication in waste water. In terms of structural policy, highly specialized medicine is being centralized in university hospitals. Smaller hospitals face the challenge of remaining attractive as employers for specialists. If demanding operations can no longer be performed in the regional hospital, surgeons are turning to centre hospitals. In the case of the nursing professions, on the other hand, increasing academization is leading in some cases to overqualified personnel for simple tasks. This further training and wage costs place demands on the hospital budget. The requirements of the labour law have continuously increased in practical implementation. The planning of staff deployment to meet the needs of the hospital is becoming increasingly complex. It is necessary to take into account the concerns of the labour law, the quality of service, the economic management and the employees. The acute shortage of qualified medical staff accentuates this problem. Attractive working conditions are more important than ever.

Unbundling for more entrepreneurial freedom
The intention behind the partial revision of the KVG is, in addition to improved transparency of services and costs, the implementation of quality competition. To this end, hospitals were granted more entrepreneurial flexibility. This leads to the desire for unbundling of state structures. The transition to private-law institutional forms can be a forward-looking step that enables clear demarcations and shorter decision-making paths. Ultimately, however, all forms of organization require skill, know-how and experience in all areas of management and a management that is open to new ideas. The involvement of experts can help to orient and relieve the tension between entrepreneurship and performance mandate.