Daniela Thiesen fights for the hospital in her small hometown of Adenau in western Germany. Despite the frigid temperatures, she has taken to the streets to protest against the planned closure of the city’s only hospital, the St. Josef Clinic, scheduled for the end of March 2023.
“We also need good clinics in the countryside, not second-rate care,” said Thiesen, who participates in the citizens’ initiative for health care in the town of 3,000.
Adenau’s surgical department closed three years ago. Currently there are only 74 beds and departments for acute geriatrics, internal medicine, radiology and outpatient surgery. The St. Josef Clinic, established by Franciscan nuns in 1863, is making a loss and doesn’t even have enough staff to care for the dwindling number of patients.
Thiesen has many stories to tell, such as that of a stroke patient who had to be driven 150 kilometers (93 miles) to a hospital in the state capital, Mainz, because there was no clinic nearby. Or the old woman who had to wait three hours for an ambulance to arrive at her house, even though she was in severe pain.
“I can see the primary school from my house, and three weeks ago a child had an accident there and an emergency helicopter had to come from Luxembourg to take him to a hospital in Trier, 100 kilometers away. We are not third class. people here, legally we are entitled to standard care,” he tells DW.
Thiesen’s anger is directed at politicians and the operator of the local hospital. The Catholic social enterprise operates the Marienhaus Group of hospitals in three federal states, including homes for the elderly and a handful of hospices and youth welfare facilities.
Marienhaus spokesman Dietmar Bochert, who has the thankless task of defending the closure of the St. Josef Clinic, said things have changed. “Today, patients go directly to large clinics or specialists instead of the local hospital,” he said.
Only 20 of the 74 beds have been occupied in recent years at any given time, mainly those in the geriatric ward. In 2019, only five life-threatening emergencies were treated at the St. Josef Clinic, and the ambulance has been heading directly to other clinics for years. The hospital’s total deficit now amounts to 10 million euros (10.6 million dollars).
And this year the clinic received a fatal blow. “The Association of Health Insurance Funds, the Association of Private Health Insurers and the Association of German Hospitals recognized the lack of demand in Adenau and removed the clinic from the list of hospitals entitled to safety benefits,” Bochert said.
In other words, the clinic was no longer considered indispensable, a status it still held until the end of 2021. Bochert is in the process of finding new jobs for the 55 full-time employees. The fact that San José has no future is mainly due to the situation on the field. Even company e-bikes and a good pension plan are often not enough to attract new staff.
“We’re all over social media and recently even started several ad campaigns to find employees,” he said. “In one case where we were looking for a senior doctor, we couldn’t convince anyone, even though we approached 100 candidates through headhunters. But, at the end of the day, recruiting always fails when you say the job is on.” Adenau. Then they quickly say ‘no thanks’.”
Government plans a ‘revolution’ in health care
Health Minister Karl Lauterbach is planning a major hospital reform that he calls “a revolution.” The plan is to have a three-tier hospital system.
Level 1 are clinics that offer basic care; some of them may have a well-equipped emergency room. Tier 2 consists of hospitals offering standard and specialty care. Level 3 are hospitals with a wide range of specialized care, such as large university hospitals. And there will be equipment specifications, patient rooms, number and qualification of staff for each category.
Klaus Emmerich is upset by these plans. In the Bavarian town of Sulzbach-Rosenberg, which has a population of 20,000, he was on the board of directors of the local hospital.
“If the next hospital ends up being more than a 30-minute drive away, then that’s dangerous and can be life-threatening for individual patients.”
According to his calculations, 650 hospitals in Germany are in danger of becoming mere glorified nursing homes. The German Ministry of Health envisions that such basic clinics could be run by qualified nurses instead of doctors. It is also planned to increase outpatient care, that is, through doctors in private offices, and transfer patients to level 2 or level 3 hospitals only in case of emergencies.
For Emmerich, this amounts to “pure mockery to talk about ‘hospitals’ when there is nothing more than glorified short-term or outpatient care. We will end up with many regions in rural areas with inadequate medical treatment.” He said “second category” means no more 24-hour medical availability, no more inpatient ER with a trauma room for resuscitation, and no more CT scans.
More quality than quantity
Reinhard Busse, professor of health care management at the Technical University of Berlin, takes a completely different view, rejecting the idea of keeping as many clinics open as possible and then equipping them with minimal standards.
Busse believes in the “less is more” approach and believes that no clinic is better than a bad clinic.
“We have too many hospitals in Germany. Some districts have three smaller hospitals, all poorly equipped. Instead of three bad hospitals, it’s better to have one good one.”
Busse is also one of 17 scientists and doctors who lashed out at Lauterbach’s talk of revolution. With 466 billion euros ($495 billion) in healthcare spending last year, Germany can afford one of the most expensive systems in the world. Only the United States spends more of its gross domestic product on health care. So there’s no lack of money, Busse said, it’s just poorly distributed.
“Hospitals are absorbing more and more doctors like a sponge, which partly explains the lack of resident doctors. We also have a lot of nursing staff compared to other countries. But because we have a lot more beds and a lot more hospitalized patients, we end up with a relatively poor nurse-patient relationship because we spread resources so widely.
Hospitalization is too expensive
Germany has 425 hospitals that would fall into the new level 2 and 3 categories, Busse said. “They are the backbone of care,” he added, arguing that they should be the focus of a reform that he believes is long overdue.
“Seventy percent of pancreatic cancer patients in Germany are not treated in cancer centers, but in hospitals without any specialization,” Busse said. This doesn’t make sense to him. “We now want to introduce the logical principle that hospitals should only treat cases if they have relevant expertise in that particular area.”
This article was originally written in German.
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