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“We feel the economic pressure enormously“

Cancer Center: “We feel the economic pressure enormously“


Photo: Jörg Haier

Professor Jörg Haier; © private

If you are referred to a hospital as a tumor patient, you will need complete treatment care and usually intensive therapy. Administrative proceedings and political requirements on the hospital end are added, all of which are not always easily carried out.

But what kind of benefits result from a comprehensive collaboration at hospitals, what is appreciated by the patients and how do the parties involved deal with the new Health Care Reform? spoke with Professor Jörg Haier, Managing Director of the Comprehensive Cancer Center Münster (CCCM). Professor Haier, the CCCM serves the comprehensive management of tumor patients, but it is also engaged in international collaboration and consolidates translational tumor research at the University Hospital Münster. Why this grouping of different functions?

Jörg Haier: This happened during the development. For the past three years we have intensively strived toward the advancement of comprehensive structures and expedited this for some time now with a corresponding performance structure. At the same time, due to the intense growth of the number of foreign patients, it was necessary to coordinate everything precisely. Particularly in the area of oncology we have many patients from foreign countries and thus very intense contact to other countries – my job as CCCM director is to organize these convergences, even though the two operating areas – treatment and organization – only partially overlap. How many patients do you treat per year?

Haier: We have about 7000 inpatients and just about as many outpatients with compulsory and private health insurance coverage. Of these, about one to two percent come to us from foreign countries. Do you also notice the need to cut costs, which puts pressure on many hospitals? After all, you are also trying to get new therapies and treatments for cancer off the ground, which ultimately involves cost, also through acquisition of new equipment.

Haier: We feel the economic pressure enormously. One reason why we expedited the development of a comprehensive tumor center, is related to the economic aspect of treatment effectiveness: it is our goal to avoid redundant examinations for example, to shorten courses of actions for everyone and to speed up patient flow, so that all in all a better account of our courses of action and simultaneously an improvement of patient satisfaction takes place. Of course this also manifests itself in that despite an increase in the number of patients, the number of personnel remains constant or -if anything- decreases.

On the other hand I notice that the economic stimulus package at the beginning of this year also provided a few positive aspects for us. Several investments in equipment were made possible, which normally would not have taken place or only with a significant delay. In that, you can actually talk about a burst of investment.

As far as expensive drugs are concerned, of course we are always under big pressure, because they need to be refinanced. This requires a very intense negotiation with the health insurance companies, which thus far has always been successful. More often the question here is whether the drugs that are being used actually have adequate benefits. This is a popular discussion, which is currently very intense. Although it is a little lopsided on the part of the health insurance companies, since they exclusively argue from an economical stance and medical aspects in part take a back seat. But there are things that are difficult to assess economically.

A classic example for this is that for children for example, verifying the effects of drugs is sometimes downright difficult to determine – strictly methodically speaking –, because perhaps the illness is rare or because certain data cannot be applied from adults to children just like that. The controversy of this requirement is shown by another example. Based on today’s criteria, by which we are only allowed to do everything with the highest scientific evidence, would mean for instance that we would have never been allowed to introduce Aspirin.

Unfortunately, in this respect this is a debate that is affected too much by economics and is bypassing the main issue – namely, to preferably set up structures, which enable us to generate as much knowledge as possible from what we do. We can then draw from these resources. It is certainly problematic to accomplish all this with backlash politics.

Photo: Money and stethoscope

Health costs money - the new german health reform does not change that, unfortunately; © Reitz-Hofmann Are there actually differences that are based on cost issues on the part of health insurance companies when it comes to treating compulsory or privately health insured patients?

Haier: This actually almost never occurs in our hospital. Of course there are individual health care benefits, but this nearly does not affect the area of cancer medicine. There might be some benefits in the service- or prevention area, which is why privately insured patients come earlier to us. Whether this makes sense however remains to be seen, because there is a whole array of arguments against prevention, that happens too early. However, as far as using materials, at least concerning the inpatient area, this is not in dispute. This is also the case in the outpatient area in terms of the actual medicinal treatment – there are definitely some supportive treatments, like for example vitamin therapies or similar things, which are not paid for by the compulsory health insurance fund. Or the patient needs to pay for it themselves. What kind of effects do you think the upcoming Health Care Reform will have on your work?

Haier: The number and rate of reforms is definitely a problem. We cannot estimate the effects of the last reforms yet. And now there are already more changes required, which make it downright difficult for us to actually adjust to them. The confidence in our actions is therefore very restricted.

Although we strive to perceive this dynamic in medical science virtually as a daily routine, according to our experience thus far, the expected impacts have for the most part not occurred as expected. There was a temporary curb in cost, which will lead to redistribution. A classic example for this is the question of varied settlement- and deduction modalities, respectively, for chemotherapies. Here the pharmaceutical industry was very quick in applying pressure in this case just to reduce the corresponding deduction premiums or the like in other places, so that overall costs changed rather marginally. To this extent, I think these very fast-paced politics of change that are based on little experience should be at least critically assessed.

The interview was conducted by Simone Ernst and translated by Elena O’Meara


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