Criticism of the DRG System – "More Time for People and Medicine"

The call of doctors and associations against the alleged domination of the economy in the health system has caused a stir. Andreas Tecklenburg, doctor and vice-president of the Hannover Medical School, said: "The excessive emphasis on the economy has made our work increasingly unprofitable."

Dr. Tecklenburg, in the latest issue of Stern, hundreds of doctors and associations criticize the growing economy of health care. Do you support this call?

The signatories make good arguments and launch an important debate. I would like to add the following three points – DRG system reform, end of the economically-controlled over-treatment as well as sub-supply and adequate equipment of the hospitals: let's not forget the working conditions! One of the biggest problems is finding enough people for care and the medical profession.

And this is due to the economy of the health system?

Not only, but also. If the economy means the economic use of funds, you get me right away on your side. However, the focus on the health care economy has made us less and less economical today. We are using more and more staff and resources in non-medical areas, the bureaucracy is eating more and more time. Doctors and nurses who want to work socially, however, feel the need to have time for others and to interact with them. Instead, they experience the alienation of their work and a culture of mistrust in the hospital. The best example is the MDK exam. We finally need more time for people and drugs.

Is there a surplus or under-supply triggered economically in the hospital?

Yes, they exist. Hospitals often provide services for which they are not paid because they repaint the MDK. When a 90-year-old woman gets a valve replacement, we should not start it before the day of the surgery. It's absurd and, although we know that the MDK removes the extra day, we always take the patient sooner. If clinics no longer provide services for which they were not paid, it would look grim.

Is too much surgery done in Germany because it is worth it?

The system is very open for that. There are areas in which surgical procedures such as mushrooms on the back of the soil are slaughtered. Professional societies have rightly criticized this in the past. I myself know doctors who worked in hospitals, where they were asked to make a list of specific exams for private patients. Not all hospitals do it, but they do exist.

Are the critics right: is the DRG system at the heart of all ills? Do we need a system change?

The introduction of lump sum payments has introduced transparency into the system and has been a milestone, and I still uphold it today. Of course, as in any system, there are incentives and an intrinsic motivation system. Shortly after the introduction, everyone knew how to best use the system for himself. In this respect, the DRG system is too vulnerable.

But many studies and data on quality conclude that the DRG system has not led to any deterioration in quality, on the contrary …

I consider that the benefits of the quality assurance currently in use are very doubtful, as the quality of the indication is totally ignored. I would be happy to finally be able to focus on that, as it would solve many of the issues under discussion.