GKV-Spitzenverband: “No understanding” for constitutional complaint against minimum quantity

Berlin. The GKV umbrella association appears to be granting a constitutional complaint filed by three federal states against minimum quantities, particularly for premature baby care, a chance of success. They view the lawsuit "with great concern," it said in a statement on Thursday. Board member Dr. Martin Krasney indicated that he considers the states' actions unacceptable from a medical ethics perspective.

"We have no sympathy for the complaints. At a location with a higher caseload, the children's chances of survival are proven to be significantly higher and the risk of lifelong health problems is lower."

At the beginning of the week, Baden-Württemberg's Ministry of Social Affairs took the lead in announcing the move to Karlsruhe, arguing that the Federal Joint Committee (G-BA) was "interfering with the states' responsibility for ensuring inpatient care and was practically undermining it."

"Rigid" caseload requirements jeopardize nationwide premature baby care, and "delays in care and bottlenecks" are to be feared. In 2020, the Federal Joint Committee (G-BA) increased the annual minimum volume for the care of newborns weighing less than 1,250 grams from 14 to 25, effective 2024, a figure that many Level 1 perinatal centers fail to achieve.

In contrast, the GKV-Spitzenverband (Statutory Health Insurance Association) points to a model already successfully practiced in the state of Baden-Württemberg, which delegates care to a center of excellence. In the Ulm Neonatology Working Group, premature babies are "no longer cared for by the participating perinatal centers themselves."

Instead, "pregnant women are referred to the central location in Ulm before delivery. Once the children are medically stabilized, they are transferred to the cooperating locations."

DKG: “right and important”

It goes on to say that two years ago, hospital directors of the largest perinatal centers in Baden-Württemberg appealed to Health Minister Manfred Lucha (Greens) to “establish the Ulm concept in other regions” and thus “implement the new minimum quantity in his state as well.”

Meanwhile, on Thursday, the German Hospital Association (DKG) welcomed the states' lawsuit as "an opportunity to have the constitutionality of the extent to which G-BA guidelines and federal regulations may influence or restrict the states' hospital planning examined." This, it added, was "right and important, not least in light of the upcoming hospital reform." It therefore hoped for a quick decision.

In principle, minimum volumes are undisputedly a suitable quality assurance tool ("to avoid occasional care"). The question is simply "whether the Federal Joint Committee's minimum volume regulations, in their current form, are actually compatible with the states' hospital planning authority." This also applies to the staffing requirements for psychiatric and psychosomatic clinics, which are also the subject of the state lawsuit.

Immediately after the announcement of the constitutional complaint, the impartial G-BA chairman, Professor Josef Hecken, rejected the allegation that the self-governing body was interfering in hospital planning—"the G-BA doesn't do that." Rather, caseload and staffing targets serve to implement the social law quality requirement and ensure patient safety.

“Quality – no matter which state”

The Federal Joint Committee (G-BA) also by no means ignores regional circumstances in its impact assessment. "It is obligated to do so, and it pays close attention to it," Hecken assures. The statutory mandate, which the committee fulfills, is clear: "It should ensure that patients receive good quality care, regardless of which federal state they are treated in."

Disputes over standards for inpatient care for premature and newborn babies have long existed. The Federal Joint Committee (G-BA) first issued a binding volume requirement in 2008 (at that time, 12 cases per year). A first ruling by the Supreme Court followed just four years later. At one point, the G-BA had wanted to require perinatal centers to treat at least 30 premature babies per year. However, the Federal Social Court only allowed 14; evidence of quality improvements from a 30-case threshold was lacking.

At the end of 2015, the highest social court judges in Kassel dismissed a lawsuit filed by several hospitals against the case number of 14. The reason given, among other things, was that premature births were predictable services, the provision of which the Federal Joint Committee (G-BA) was authorized to regulate through minimum quantities. This was "constitutionally unobjectionable." (cw)