Hospice and Palliative Care Act to be adopted by the German Bundestag

Key elements of the Act

The motivation behind the Hospice and Palliative Care Act is to create incentives to establish and expand hospice and palliative care that promote cooperation between the relevant care areas and lead to better provision of information to patients about the care on offer. Some of the measures intended to implement these requirements are set out below:

• The legislator starts by explaining that treatment of sick people also includes palliative care and that nursing care also includes care for the terminally ill. Thus palliative care and end-of-life care are among the standard services provided by the statutory health insurance funds and are part of the social long-term care insurance fund’s mandate to provide care.
• Hospices caring for in-patients are to be provided with financial support above all through two measures: on the one hand, the statutory health insurance funds will bear 95% of the eligible costs (currently 90%) for hospices for adults and not just for children. On the other hand, the minimum daily rate payable by the statutory health insurance providers to the hospice per insured patient will be increased from 7% to 9% of the monthly reference value under section 18 I of Book IV of the German Social Code (Sozialgesetzbuch IV) (meaning an increase from 198.45 euros to 255.15 euros in 2015 alone).
• Up to now, out-patient hospice work has been supported by subsidies paid towards personnel costs. In future, the health insurance funds will also contribute towards the cost of materials.
• In order to expand the range of specialist palliative out-patient care offered, an arbitration procedure will be introduced for this area that is designed to speed up the conclusion of contracts between the health insurance funds and providers of this kind of care.
• The doctors under contract to the statutory health insurance funds will be actively involved in promoting cooperation between those engaged in providing care and in coordinating and improving the quality of services offered. They will be paid extra remuneration for this by the health insurance funds.
• Nursing homes exclusively offering in-patient care will be required to provide the nursing care funds with reports on their cooperation with a network of hospices and providers of palliative care. Moreover, it is planned that they will enter into cooperation agreements with the doctors under contract to the health insurance funds in the future in order to improve out-patient medical care in such facilities.
• A statutory basis will be created to allow nursing homes to offer their residents an individual care plan for medical, nursing, psychosocial and pastoral care in the last phase of life. This will be financed by the statutory health insurance funds.
• Palliative wards are to be given the right to agree hospital-specific fees rather than charging fees calculated according to a nationwide flat rate.
• Insured patients will be entitled to counselling from the statutory health insurance funds regarding the various hospice and palliative care on offer.

The Hospice and Palliative Care Act is a law amending existing legislation. The reforms described above will mainly be implemented by amending the provisions in Book V of the German Social Code (Statutory health insurance). But Book XI of the Social Code (Social nursing care insurance) and the Hospital Funding Act (Krankenhausfinanzierungsgesetz) will also be amended.

Political and economic relevance

The German Bundestag, the lower house of parliament, is currently engaged in extensive discussions on issues relating to the end of human life. The topic of euthanasia is on the parliamentary agenda just one day after the anticipated adoption of the Hospice and Palliative Care Act. The question of whether terminally ill patients should have access to effective therapies to reduce pain, and by what means, may also be important for the stance taken in relation to euthanasia.

But the Hospice and Palliative Care Act is also relevant as far as its financial effects in the health sector are concerned. The German Federal Government assumes that the package of measures will lead to additional annual expenditure in the low to mid three-digit million range for the statutory health insurance providers. Part of these funds will be used for the additional remuneration to be paid to practice-based physicians. However, the incentive and promotion instruments set out in the Act also have an impact on a wide range of other service providers (hospitals, nursing homes, in-patient and out-patient hospices), meaning that there are likely to be economic effects in the entire hospice and palliative care sector. The economic relevance of some instruments depends above all on whether they are taken up by the relevant stakeholders. Only experience will show how far hospitals make use of the opportunity to negotiate individual fees for their palliative wards, for example, and how successful they will be.

Outlook

The response to the Government’s bill by the experts during committee consultations was mostly positive, despite requests for minor changes. Although the opposition parties believe that the bill is heading in the right direction, they say that it does not go far enough.

The adoption of the Act by the German lower house can be regarded as certain. If amendments are adopted in the final readings, they are likely to be relatively limited and should not affect the basic orientation of the Act. The Act is expected to be passed by the upper house as well (the Act will come into force on the day after it is pronounced).