Coronavirus pandemic in Germany: Medical care in an adaptive healthcare system

The authors recommend a needs-based system focusing on patient well-being and quality assurance, rather than a primarily profit-oriented approach. It should appreciate all employees and integrate innovations as well as digital solutions. The aim is an adaptive healthcare system where the public health service and the ambulatory and stationary sectors work together well, and research results are promptly integrated into clinical practice.

In the past weeks, the coronavirus pandemic has posed extraordinary challenges to the German healthcare system. According to the ad-hoc-statement, the confrontation with a new viral disease has shown the great importance of a publicly funded healthcare system and of an interconnected and research-based healthcare. Due to precautionary measures against infection with the largely unknown SARS-CoV-2 virus as well as the rearrangement of the system to be able to handle a potentially large number of severely ill COVID-19 patients, ambulatory and stationary care for patients with other illnesses has, however, faded into the background. Even important preventive measures and research activities had to be interrupted. Now, needs-based preventive, diagnostic and therapeutic measures for all patients need to be resumed promptly and, whenever possible, to their full extent.

The authors consider the following short- and medium-term framework conditions necessary to ensure healthcare for all patients in times of an ongoing pandemic threat:

• provision of sufficient stationary, ambulatory, and post-stationary capacities and securing personnel, rooms and technical reserves for the treatment of COVID-19 patients when required
• establishment of a regional and in-hospital early warning system for SARS-CoV-2 infections
• implementation of science-based targeted testing strategies
• strengthening public confidence in a safe and patient-oriented medical treatment
• high-quality care and health services for all patients by promptly integrating new research developments

It is the responsibility of the state to ensure healthcare in times of crisis and a quality-assured and science-based medical treatment for the population. The working group of the German National Academy of Sciences Leopoldina recommends taking the following general aspects into account for the long-term development of the healthcare system:

• ensuring high-quality, science-based and ethically responsible care for all patients
• determining defined and differentiated areas of responsibility for each healthcare provider in a region according to the level of care expertise with a special function for university medicine
• providing adequate numbers of qualified medical and care staff
• guaranteeing comprehensive digitisation and structured cross-sectoral connectivity of all hospitals and of ambulatory care
• ensuring the realization of healthcare tasks, for example by supplementing the current diagnosis related groups (DRG) reimbursement with structural components while avoiding false incentives
• social appreciation, appropriate remuneration, attractive and needs-based training as well as favorable working conditions for medical and non-medical personnel

With this statement, the German National Academy of Sciences Leopoldina publishes the fourth ad-hoc-statement on the coronavirus pandemic in Germany.

The first three statements focused on acute healthcare policy measures in dealing with the pandemic, and on psychological, social, legal, educational, and economic measures that may contribute to a gradual return to societal normality. The corresponding documents can also be downloaded at: www.leopoldina.org/en/coronavirus