The Eastern Herald (TEH): Mr. Kessler, due to the rapidly increasing number of corona cases, hospital capacities and nursing staff may be overloaded. Is the German healthcare system well prepared for crises like the corona pandemic?
Achim Kessler: All in all, of course, we have high-quality health care in Germany, but the privatization and commercialization of the health system have meant that capacities and treatment options have been steadily reduced in recent years. In order to increase profits, wages in the hospitals were cut, jobs were cut and work was concentrated.
The result is the nursing emergency, which makes everyday operations a challenge. With this in mind, unfortunately, we have to say that our pandemic health system is not well-positioned. If a lot of people get infected in a very short time, we quickly reach the limits of the health system because the staff is already insufficient.
How can a staff emergency be prevented?
I am of the opinion that the payment in nursing care must now be increased by a flat rate of 500 euros. These people are doing invaluable work for our society. We have to try to persuade people who work part-time to increase their hours. This will only succeed if it is linked to appropriate incentives. The federal government should also call for people to report who previously worked in nursing and are now active in other areas.
How should this wage increase be financed?
We need an emergency fund for such tasks. We have a protective shield for the economic sector. We also need such a fund for the health system in order to be able to finance short-term measures. This includes setting up intensive care beds and hiring additional nursing staff in the hospitals and nursing facilities.
Germany has 28,000 intensive care beds, 25,000 of them with ventilators. A high bed density in a European comparison. Do we complain at a high level?
It’s always relative. We had 500,000 hospital beds in 2017, a quarter less than in 1991. These are the beds that we now lack and that the government plans to use in the sports halls and hotels.
Of course, 25,000 intensive care beds with ventilators are a relatively high number compared to our European neighbors. But you have to remember that 80 percent of these beds are already occupied by other patients. That is why the Federal Government has announced that it will purchase 10,000 new ventilators,
In recent years, public debate has often centered on overcapacity in hospitals. Why is there a shortage now?
In recent years I have had to constantly hear that our healthcare system has to become more cost-effective, that we have too many beds, that hospitals, especially in the countryside, have to be closed. I don’t hear anything about that anymore. On the contrary: Now even Health Minister Spahn is arguing that this is exactly why our health system is well-positioned. I can only hope that this knowledge will become established and that it will remain in consciousness even after the crisis.
The financing of hospitals in Germany is revenue-oriented. Payment is made per patient case according to the so-called case flat rates. As a result, some hospitals are reluctant to postpone lucrative surgeries in order to free up beds for corona patients. Are economic efficiency and needs-based supply in conflict?
This lump sum financing is completely absurd. Imagine that the police or the fire department are paid according to the number of missions they drive. No one would come up with such an idea and it is completely incomprehensible that something like this should work in the health system. Because of the lump-sum funding, every bed that is not occupied is an “excess capacity” for the hospital operator that has to be dismantled. Ultimately, this also means that no capacities are maintained for emergency situations. There is no buffer for emergencies.
And against the background, there is now also the danger that private hospitals will not make their beds free for corona patients, as requested by the federal government. I understand that the Ministry of Health also sees this danger and plans to introduce directives against private hospitals next week.
How can a care-oriented to the common good be guaranteed?
We demand that the hospitals be brought back into public hands. This also means that they must be financed again to cover their own costs. The case flat rates must be abolished and the hospitals financed in such a way that the focus is on care. This also means that, for example, the health offices, which are very understaffed, must be financed again properly so that they can take on their tasks to protect the population – not only in times of crisis but also in normal operations.
In nursing, we have to make sure that there are enough nursing staff, not only in the hospitals but also in the nursing homes. This means that wages have to be raised properly and that all health care professions, which are still predominantly female, are paid properly.
Why is there relatively little criticism of the Federal Government’s actions these days?
I share the measures that the federal government has taken so far to flatten the epidemic. I think it is right to ask the population to stay at home and to close certain shops. But beyond that, it is important to realize, even now in the crisis, that certain difficulties that we now have are home-made and urgently need to be addressed.
I believe that if the situation worsens, hospitals must be nationalized to solve the problem. You can’t wait until the pandemic is over. We now also need a societal discussion about further restrictions on civil rights, which cannot simply be prescribed.
Are pandemic control measures such as curfews in conflict with civil rights?
If curfews are imposed, it must be transparent and socially discussed. Such measures must not be adopted without parliaments’ involvement. As I said, I share the previous measures to limit social contacts. But if there are general curfews now, I see it very critically.