A revolution took place last week in Germany, when the German federal government created something that had never been created before—a one-stop website providing details of quality outcomes data and patient satisfaction data from more than 1,700 hospitals across Germany. Here in the United States, consumers have long had a very wide range of informational resources to go to, with which to judge the quality outcomes and patient experiences of hospitals and health systems, though they have never been gathered together in a single place online. But in Germany, a federal government website has until now only functioned as a directory, lacking qualitative appraisals of any kind.
As a result, the German healthcare system, though considered one of the best in western Europe, has until now remained opaque to healthcare consumers, who have had no real insight into which hospitals might be better than others, along a variety of dimensions.
As of Friday, May 17, that has now all changed. As an English-language article in the national Deutsche Welle media outlet noted, “The Federal Hospital Atlas or Bundes-Klinik-Atlaswebsite was launched online for German residents since Friday. The new portal allows patients to learn online about the strengths and weaknesses of individual hospitals in Germany.”
"With the Federal Hospital Atlas, we are offering patients a clear guide through the hospital jungle in Germany," said German Health Minister Karl Lauterbach at the launch in Berlin. "With just a few clicks, they can compare hospitals and find the best hospital in their area for the treatment they need."
The Deutsche Welle article went on to note that “The portal provides information on each and every one of the approximately 1,700 clinics in Germany. However, not all information is available immediately. The atlas will be gradually updated over the coming months. The legal basis for the atlas is the Hospital Transparency Act passed by Germany's parliament in March. The atlas is part of Lauterbach's reform of the hospital system, which is aimed, among other things, at increasing specialization.”
And Deutsche Welle noted that “Patients can already use the atlas to find out which facilities offer which procedures, how often they are performed there, and how many nursing staff are available on site. There is also an indication of which clinics have certificates as proof of their level of specialization in certain treatments. According to Lauterbach, the complication rates for selected surgeries will also be published ‘in a few weeks.’ In other words, data on what goes wrong and how often. Such data is already being collected, but not published. "This will mean that patients will be more selective about their surgeries," says Lauterbach. The fact that some hospitals are then avoided for certain procedures is entirely intentional, the minister said. He pointed to studies that show "very large differences" in the quality of care at individual hospitals.”
Meanwhile, the May 17 announcement by the German federal government noted that, “More information about the quality of hospitals for all patients – that is the goal of the Hospital Transparency Act, which the federal government initiated. The central instrument is the digital Federal Hospital Atlas, which has now gone online.”
The Federal Hospital Atlas’s website itself notes that “The Federal Hospital Atlas is continually being developed. We record information from practice that can be reported using a contact form.”
And Professor Claus-Dieter Heideck, Director of the Institute for Quality Assurance and Transparency in Healthcare (in German, “Institut für Qualitätssicherung und Transparenz im Gesundheitswesen,” or IQTIG), on the Federal Health Ministry’s website, lauded the federal government, stating that “The Federal Hospital Atlas is a groundbreaking element of patient information. The portal enables patients to make well-informed and well-founded decisions when selecting a hospital, whereby he or she can click down to the smallest level of detail in the Federal Hospital Atlas. The Federal Hospital Atlas can also serve as a catalyst for further developing the data basis for quality assurance and thus creating an offer that is truly oriented towards the information preferences and needs of patients.”
Newspapers provide broad coverage
All the major German newspapers and news outlets published articles and video reports about the website’s debut. A report on May 17 in the highly respected Munich daily Süddeutsche Zeitung began thus: “Where to go for a new knee joint or major cancer surgery? A new “Federal Hospital Atlas” can now help when deciding on a hospital. The state comparison portal was launched on Friday and is intended to provide information about services and treatment quality at almost 1,700 clinic locations throughout Germany. Health Minister Karl Lauterbach (SPD) spoke of a ‘clear guide through the hospital jungle’ that should also enable new regional comparisons. There was sharp criticism from the hospital industry. Patient representatives welcomed the goal, but also see gaps.”
The Süddeutsche Zeitung report went on, “Lauterbach said that understandable information about good hospital care is now accessible to everyone and is no longer just the privilege of a few experts. Transparency is urgently needed with around 16 million hospital treatments and 500,000 new cancer patients per year alone. Most patients do not have a good idea of which clinic is particularly suitable for their treatment. And there are very big differences in treatments such as colon cancer operations. Compared to existing information portals,” the article noted, “Lauterbach made it clear that what is unique about the Federal Atlas is the way in which data is prepared for patients. “With just a few clicks you can compare clinics and find the best clinic in your area for the treatment you need.” This means you can see and assess ten clinics right next to each other instead of having to “hop from clinic to clinic”. According to the ministry, there were more than five million hits in the first three hours, and some page views were briefly interrupted. The portal www.bundes-klinik-atlas.de will gradually include additional data.”
Meanwhile, with regard to Health Minister Lauterbach’s statements upon the unveiling of the Atlas, reporters Matthias Bartsch, Holger Dambeck, Milena Hassenkamp und Martin U. Müller wrote on May 17 in the prestige Hamburg magazine Der Spiegel, that, “Compared to existing information portals, Lauterbach made it clear that what is unique about the Federal Atlas is the way in which data is prepared for patients. ‘With just a few clicks you can compare clinics and find the best clinic in your area for the treatment you need.’ This means you can see and assess ten clinics right next to each other instead of having to ‘hop from clinic to clinic,’” the reporters wrote. “According to the ministry, there were more than five million hits in the first three hours, and some page views were briefly interrupted. The portal www.bundes-klinik-atlas.de will gradually include additional data,” they wrote.”
Of course, this leap into consumerism has not taken place without grumbles. As the business weekly Wirtschafts Woche reported on May 18, “The German Hospital Association criticized the federal portal as ‘political activism at the expense of the taxpayer.’ It does not provide patients with any additional information and cannot act as a useful supplement. It would bring even more bureaucracy to the hospitals. The hospital industry recently developed its own online overview. More search functions are now possible on the ‘German Hospital Directory,’ which has existed since 2002, that unbylined article stated.
Of course, grumble as hospital executives might, they don’t really have any advocacy leg to stand on, because in the German system, the federal government’s actions through the Health Ministry are pretty much the final word.
What’s more, the European publication Hospital Management noted on May 20 that “Lauterbach also highlighted the significance of the portal at a press conference, stating that “understandable information about good hospital care is accessible to everyone and no longer just the privilege of a few.” He also noted that the portal serves as ‘important preparatory work for the upcoming hospital reform.’ The Federal Hospital Atlas has been launched as part of the Hospital Transparency Act, spearheaded by the Federal Government to accompany the proposed Hospital reform. The Federal Cabinet has already put forward a draft for a Hospital Care Improvement Act.”
All of this is by way of saying that the German healthcare system, widely noted for its quality and high level of technology, has now officially entered the new era of healthcare consumerism. For German society, that’s a really big deal. ON the one hand, there is no European society that is more sophisticated—or demanding—in terms of general consumerism, than Germany society. But, for a variety of historical reasons, a skein of paternalism has dominated hospital operations in the German healthcare system. So this innovation really matters.
Obviously, the United States has a far more complex healthcare system, with our strange mix of public and private elements; and that makes it difficult for consumers to assess healthcare quality and patient experience. At the same time, we here in the U.S. have had numerous informational resources—if scattered across a very broad range of entities—that consumers have been able to consult. So it will be fascinating to see how this all plays out, and particularly whether German consumers actually make differential decisions around which hospitals to choose for their care—a pattern that has never existed before. Consumerism is evolving forward in the United States, in Germany, across Europe, and elsewhere. And every healthcare system will see different particular developments. But the fact of consumerism itself will inevitably surge forward, across healthcare systems of all kinds.
