Is the German government setting the right priorities to ensure high-quality and affordable healthcare in the future? More than half of Germans say no, according to a representative survey commissioned by the Bosch Health Campus of the Robert Bosch Stiftung.
In the last three years, the percentage of Germans who trust that healthcare policy will ensure quality and affordable care has fallen from 70 to 40 percent. The figures are alarming. There is less and less public trust in the ability of politicians to provide high-quality and at the same time affordable healthcare. Is this because policymakers are insensitive to people's needs or because projects are being implemented too slowly and indecisively? When it comes to digitalization, at least, the latter seems to be the case. A newly released survey again shows that the vast majority of citizens would like to benefit from opportunities offered by digitalization in the healthcare sector. Contrary to earlier suggestions by individual interest groups, this also includes sharing health-related data to improve individual care and support care-related research. Now, German Health Minister Karl Lauterbach has finally presented the German government's digitalization strategy for the healthcare sector. This was followed a few days ago by news that the digital patient file will be introduced countrywide by the end of 2024 – a welcome development. These words will hopefully be followed by actions – because implementation is long overdue.
As part of the initiative "Restart! Reform Workshop for our Healthcare System" initiative, the Bosch Health Campus of the Robert Bosch Stiftung has commissioned the forsa research institute several times in recent years to develop proposals for healthcare reform on this basis. Most recently, 1,800 people aged 18 and older were surveyed nationwide from January 25 to February 10, 2023. The results of this latest study can be found on the Bosch Health Campus news site, as well as downloadable details on the program's website.
Nevertheless, digitalization cannot solve all problems. The survey shows patients still prefer direct contact with medically trained specialists. It is important for people to have locally available healthcare providers, to get appointments at short notice, and to have more time with doctors and healthcare professionals for things like joint decision-making. In particular, chronically ill patients, people in small and medium-sized towns (up to 100,000 inhabitants) and people over 60 attach great importance to these aspects.
To address these needs, the Robert Bosch Center for Innovative Health at the Bosch Health Campus promotes so-called PORT centers (patient-oriented centers for primary and long-term care). These are anchored in the community, bundle the services of the various healthcare professions, and thus offer comprehensive and needs-oriented basic care close to where patients live.
In rural areas, however, such services are still the exception. The reasons for this include considerable legal uncertainties, for example with regard to remuneration, and few incentives for more intensive cooperation between the various healthcare professions. In principle, policymakers are on the right track in revamping primary care. For example, the German government coalition agreement provides for a new type of job, the community health nurse (CHN), who independently performs routine examinations, treats minor illnesses, manages therapies and trains patients in their own health literacy. However, this alone is not enough. The law must also clearly define which medical tasks the community health nurse may perform in the future. Only then will CHNs be able to carry out their duties in a legally secure manner. This also applies to some promising proposals made by the government’s Krankenhaus-Kommission (Hospital Commission) which aim to overhaul primary care. These include the use of outpatient facilities managed by nurses without physician supervision to cover basic care.
"The 1,000 health kiosks envisaged by the federal government could also fill a gap in the system, especially at the interface of health and social counseling. However, health kiosks alone cannot make up for the deficit in primary care, which is expected to worsen considerably in the coming years."
For this, healthcare structures must be improved at the regional level: Primary care centers, health kiosks, community medical care centers (MVZs) and social counseling centers must be seen as mutually complementary solutions. For this, new legal frameworks are required. The planned structural reform of hospitals is an opportunity to embrace innovative models that take greater consideration of the needs and living conditions of the population – the so-called social space.
One aspect that we frequently lose sight of, and to which the coalition agreement devoted merely nine lines, is prevention. The positive effects of a healthy lifestyle cannot be overestimated for the individual, society and the healthcare system. Against the backdrop of a dramatic increase in lifestyle-related diseases, we need to put far greater efforts into promoting health literacy. The entire medical billing system is geared toward treating pre-existing conditions. There is far too little emphasis on preventing diseases from developing in the first place. This must change, because otherwise we will no longer be able to guarantee affordable, high-quality healthcare in the long term. Yet it is precisely this point – affordable healthcare – that is particularly close to people's hearts. 99 percent of Germans consider it important or very important.