Why our Saphenion patient info: Bertelsmann clinic study?
In 1995 – 1996 Dr. med. Zierau was working in the hospital Gransee, a smaller hospital in the property of the city and as a non-profit GmbH. Legitimated by the degree of surgery and vascular surgery, the author was entrusted as a senior physician of vascular surgery with the establishment of its own vascular surgery department. Background was the fact that a vascular surgical care for the citizens in Gransee, Neustrelitz and the neighboring communities until then only in the Catholic hospital Neubrandenburg or in the Buch Hospital was possible. So a long drive for the patients.
In particular, the author introduced the catheter – assisted forms of therapy on the pelvic and leg arteries, as well as the classic radical varicose vein surgery. Quite quickly, the patients from the city and the surrounding areas accepted the new offer and we had much to do. The radiologist in private practice, who was attached to the clinic, was also increasingly able to carry out vascular diagnostics.
In this time, the introduction of the so-called case falling flats (DRG`s) and special fees for the payment of hospital services fell. The clinic made very good money with arterial catheter therapy and radical varicose vein surgery.
In the middle of 1996 it was surprisingly revealed to us that the clinic had been sold to the Joint Welfare Association and that, as a rehabilitation clinic, the operated patients of the orthopedic clinic Helmut Ulrici near Oranienburg would be treated in the future.
So a cold closure of thriving within the possibilities of the clinic and elimination of specialist care. Only the way to Neubrandenburg or Berlin – book remains for the patients. And employees had 2 options, retrained as rehab staff or looking for a new job. Social plans or job offers according to the qualification did not exist.
In this time then the decision of the own branch in the area of the vascular surgery fell.
Saphenion patient info: Bertelsmann clinic study – the specifications
The Bertelsmann Stiftung is known to many – we, therefore, do not want to deal with the origins and goals of the foundation. Just one small note: Brigitte Mohn, chairwoman of the Foundation for German Stroke Help, daughter of founding founder Reinhard Mohn, member of the supervisory board of Bertelsmann Stiftung and member of the management company of the Bertelsmann media group, sits on the foundation’s supervisory board. And she is a member of the supervisory board of private Rhön-Kliniken AG.
The extent to which this can lead to conflicts of interest or interests synergies, the author must leave open.
The Bertelsmann Stiftung funded the study and awarded it to the IGES Institute in Berlin.
Saphenion patient info: Bertelsmann clinic study: The specifications
The closing of over 800 clinics, the number of clinics should decrease from about 1400 to less than 600 clinics for the entire FRG. It is alleged that in many hospitals, there is no professional qualification and technical equipment to adequately handle emergencies such as heart attacks and strokes.
The training of cardiologists and anesthetists / intensive care physicians already in emergency rescue is so good that life is saved here. And in reality, when the patient is examined, the ambulance immediately decides whether to approach a smaller hospital or a specialist clinic – in 1995 the author was an emergency physician on a rescue helicopter (Christoph 3) in Cologne / Bonn, Bochum, Düsseldorf, Leverkusen and adjoining regions had been on the road every day and had to make those decisions too.
Closure of hospitals
A closure of more than 800 clinics is striking, especially in the territorial countries, here the eastern part of Germany with Thuringia, Saxony, Brandenburg and Mecklenburg Vorpommern. While there is, in fact, a formal oversupply of clinics in metropolitan areas and large cities, there is an urgent need for large – scale hospitals to supply basic and standard care hospitals. Here, in contrast to the specifications of the Bertelsmann study, the Federal Republic of Germany invests in technology and personal. Privatization of the hospitals, especially in the rural and area would not have a good impact on the universal service. Private clinic operators see the profit, it is specialized, it is saved in the staff, but never in the not-profitable basic and standard care.
The situation is different in metropolitan areas. There are 84 clinics in Berlin and 34 clinics in Cologne / Leverkusen. Here it is certainly possible to summarize similar structures about concerning specific topics and about concerning synergies between the clinics. However, without a loss of medical specialists and qualified nursing staff. For the practice in the rescue centers of large hospitals and, university hospitals is to see an extreme overload. According to those affected, patients can wait up to 10 hours at the university clinic, especially in the evenings and from Friday, until the first contact with the doctor.
Our thoughts at Saphenion:
We see the problem here primarily in the economic parameters and the personnel key. This is steamed down to the absolute minimum to save costs. A good – negative example of this is the Helios – Klinik Schwerin. So it would be fatal to talk about privatization. On the contrary, we see the responsibility for the emergency and initial care of the state governments and the federal government. Privatization leads to profit maximization – this has now lost nothing in emergency medicine.
There are 90 clinics in Saxony and 73 clinics in Mecklenburg / Pomerania. Closing regionally linked clinics here would, in addition to job losses, actually extend the path for patients to the hospital much more. And the path of privatization would once again challenge profitability. So also a specialization in profitable subjects.
Connection of established general practitioners and specialists
The connection of established colleagues of all disciplines is in itself a good idea and is also occasionally carried out in praxis. However, the outpatient medical specialist system can not be adequately integrated into emergency and rescue medicine. Here are working time, remuneration, spatial and temporal availability as hardly solvable problems. It is not for nothing that Minister of Health Spahn and his ministry have increased the weekly working hours of practicing physicians to 25 hours exclusively for health insurance patients – here, too, an unreasonable deadline situation and waiting times for home and medical specialists have become the rule.
An already widely practiced method is the spin-off of outpatient medical care centers. These are either operated by large clinics or run privately. Similar to the polyclinic system known from the former GDR, different specialist disciplines work under one roof here – with approval for the statutory health insurance bill. This is certainly a possible way to improve outpatient care. However, there are doubts as to whether this is in any case really about the improvement of outpatient basic and standard care, or rather about the provision of patients with lucrative treatment options.
To solve this problem, it is not necessary to increase the specific consultation hours. Here is probably more likely to increase the number of doctor approvals and in particular an expansion of the outpatient sector in the area and the countryside.
Also, the new computer world with possible video consultation hour solves in no way the problem of the waiting time and dates. For which doctor relies only on what has been said and shown on the screen of a computer to make diagnoses and develop therapies? Quite apart from the fact that this so-called telematics structure in acute and emergency medicine certainly can not be used to treat seriously ill patients.
Acute vascular medicine – our point of view
Our main area is vascular medicine. Again, there are a number of diseases that require a fast and professional care. In addition to the deep vein thrombosis, the acute arterial occlusion on the arm and leg as well as the ruptured aortic aneurysm must be mentioned. Stroke is in many cases also due to vascular changes (occlusion, aneurysm).
While a deep vein thrombosis can and will be treated very well on an outpatient basis, it looks rather bad in the case of acute arterial diseases – immediate inpatient treatment in a vascular center is indispensable and does not belong in the outpatient clinic. Acute occlusion of peripheral arteries may well be first treated with medication.
Dramatic it is the burst aortic aneurysm, here is a very high death rate due to long transport routes. A quickest possible admission to a specialized vascular center following an operation gives a 45% higher chance of life-saving!
Because of all these factors, there are many indications that stationary vascular centers tend to expand. In any case, there is no therapy for varicose veins – but this is a reality because it is lucrative.
Our designs are based on experience in daily vascular surgery and vascular medicine practice. Often we also have discussions about this subject with inpatient colleagues and our patients. Economic or substantive dependence on a party, foundation, authority, chamber or a medical device company does not exist. The statements represent a representation of the gained own experiences and do not claim to be complete.
Dr. Ulf Th.Zierau, PD Dr. W.Lahl, Dr. Lillie Martell
Utzius: Copenhagen – Statens Museum for Kunst
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