Freie Wähler on health and care

The Free Voters want to overhaul the structure of social insurance and add new provision components. Private health insurers, employers' liability insurance associations, and civil servants' health subsidies (Beihilfe) would in future share the standby costs of medical facilities.

The Free Voters want to rebuild social insurance. There should be new ways to save for care. Hospitals have costs even when no patient is there. Private health insurers should help pay these costs. Today only public insurers and the state pay them.

The platform speaks of renewing the contract between generations based on three principles: social responsibility, personal responsibility, and fairness between generations. Every citizen should be well cared for in illness and old age. Families are to be relieved in the medium term and be able to build their own assets. According to the platform, the cost of keeping medical structures available is currently borne only by statutory insurers and the state; private insurers, employers' liability associations, and Beihilfe schemes should contribute too.

The Free Voters want to reform statutory long-term care insurance so that the share paid by people in need of care is graduated by social criteria and capped. Nursing home residents should not have to rely on welfare because of rising costs.

People in nursing homes pay part of the cost themselves. This part is rising fast. Some residents then need welfare. The Free Voters want an upper limit on this part. People with little money should pay less.

The platform notes that care rates can be negotiated on the basis of actual costs, which secures collectively agreed wages and care quality. If this sharply raises residents' own contributions, the party says residents of senior facilities become welfare recipients, which it rejects. A reform should therefore graduate and limit those contributions.

The Free Voters want to secure nationwide medical care in cities and rural areas, including emergency care, ambulance services, and hospitals. Telemedicine, closer cooperation between outpatient and inpatient care, and pilot projects are meant to help.

Doctors, hospitals, and ambulances should be easy to reach everywhere. That includes the countryside. The Free Voters want to expand emergency care. They want more treatment by video and phone. Doctors' offices and hospitals should work together better.

For emergency care, the platform would support telemedicine, statewide integrated dispatch centers, alert apps, and local first responders. The 2024 hospital reform should be improved because, in the party's view, it neglects outpatient care; both sectors should be treated as equal. The platform keeps the principle of outpatient care before inpatient care. Pilot projects such as care hostels or attending-physician models should become possible, which requires insurers to loosen financing that is strictly separated by sector. The federal government should support programs for family doctors and rural nursing care; data protection and transparency should be preserved as medicine goes digital.

The Free Voters want to reduce documentation requirements in health care so that more time is left for patients. In the future, only deviations from the standard case would have to be recorded with a reason.

Doctors and nurses have to write down a lot. That time is missing for patients. The Free Voters want fewer rules about writing things down. Only exceptions should be noted. Computer programs with artificial intelligence should help.

In the platform's view, administration takes up working time that is missing from patient care. Providers' own responsibility should be strengthened. AI-based documentation systems are to be built up and expanded. Inspections by nursing home supervisors, trade inspectors, health offices, and the insurers' medical service should become more flexible, and structures merged to avoid duplication. The platform adds opt-out clauses, trials, and pilot projects; AI should also be used in nursing, for example for shift scheduling, with federal funding programs.

The Free Voters want to stop the further spread of investor-operated medical care centers (iMVZ). They call for statutory regulation and want to strengthen the independence of doctors' decisions.

Some doctors' offices belong to investors who want profit. These offices often form chains. The Free Voters see this as a danger for care. They want a law with rules for such offices. Doctors should decide independently.

The platform supports group practices but rejects the further spread of profit-oriented centers. According to the party, these endanger outpatient care, and private equity firms already play a strong role there. More and more practices are being combined into chains. The party demands that an already announced statutory regulation be put into effect.

The Free Voters want a fundamental reform of the system of Associations of Statutory Health Insurance Physicians and want fees paid according to actual services without caps. Independent health professions are to be strengthened through updated fee schedules, support for opening practices, and less red tape.

The Free Voters want to support doctors with their own offices. Doctors should be paid for all services, with no upper limit. People who open or take over an office should get help. This matters most in areas with few doctors. Older doctors should get bonuses if they work longer.

The reform includes digital solutions and simpler billing, grants and tax relief for taking over or founding practices especially in underserved areas, support for training resident doctors in practices, fewer clawback claims, and easier licensing. Fee schedules are to be updated and indexed; for dentists the platform points to a fee schedule unchanged for more than 30 years. The state should help independent professionals insure their remaining debt. Retention bonuses and tax breaks are meant to keep older doctors, pharmacists, and therapists working past retirement age. Medical training should follow need and favor broadly trained primary care providers; staff should be better protected from assaults and working-time rules observed.

The Free Voters want to strengthen nationwide coverage by local pharmacies and raise the fixed pharmacy fee. They want to ban mail-order sales of prescription drugs because, in their view, foreign mail-order sellers distort competition.

The Free Voters want to support pharmacies close to home. Pharmacies should get more money per medicine. People should no longer order prescription drugs by mail. The party says foreign mail-order pharmacies face fewer checks.

The platform points to about 160,000 jobs in pharmacies and calls for supporting training occupations there and funding the shift to the pharmacy of the future. The fixed per-package fee has barely changed in nearly 20 years, it says, and should rise; the party rejects different fees depending on size or performance. According to the platform, foreign mail-order pharmacies are not subject to comparable oversight. E-prescriptions, the medication list in the electronic patient record, and the KIM communication service should be expanded.

The Free Voters want to sharply reduce dependence on drug manufacturers outside Europe. In their view, Germany should again be able to supply itself with medicines.

Many medicines come from China and India. The Free Voters want to change that. Germany should make its own medicines again. The country should depend less on others.

The platform blames the health insurers' discount contracts, which it describes as a cost-saving tool. These, it says, have led to 85 percent of production capacity for prescription drugs for Europe now being located in China and India. The party wants to reverse this trend and names self-sufficient drug production in Germany as the goal.

The Free Voters want to make nursing more attractive through more autonomy, graduated qualification levels, and matching pay. In the short term, trained assistants would take on more tasks and other occupational groups would be recognized as qualified nurses.

Germany lacks many nurses. The Free Voters want to make the job more attractive. Nurses should be allowed to decide more on their own. People from similar jobs should also be able to work as qualified nurses. Hands-on training should get better.

The platform puts the gap at about 200,000 nursing staff. Medical nursing tasks could be delegated to trained assistants; special-needs care workers would count as qualified staff, as would medical assistants and occupational therapists after further training. The nursing competence bill (Pflegekompetenzgesetz) is to be taken up again, including the transfer of medical tasks. Planned levels range from a nationally uniform 18-month assistant training to university degrees. Practical instructors should get financial incentives and release time, skills labs should be used, and the state should fund training in speech, occupational, and physical therapy.

The Free Voters want to give family caregivers more support: low-bureaucracy help, financial compensation, and credit for caregiving time toward their pension. Counseling and caregiving courses should be comprehensive and free.

Many people care for relatives at home. The Free Voters want to help them more. They should get money for this care. Caregiving time should count toward their pension. Caregiving courses should be free.

Help for families should be easier to access and more tailored. Pilot projects for short-term care and short-term residential stays should receive more funding. The platform calls for comprehensive care counseling under Section 7a of Social Code Book XI and free caregiving courses. Social services in hospitals and rehab facilities should take more responsibility for care after discharge, because the platform says poor coordination leads to gaps and repeated admissions.

The Free Voters want to preserve hospitals and emergency care close to where people live. To that end, the hospital reform is to be substantially revised and hospital funding secured. The federal government is to share in keeping municipal hospitals open.

The Free Voters want to keep hospitals close to people's homes. Emergency care should be easy to reach. The hospital reform should be changed a lot. The federal government should help towns and cities pay for their hospitals.

The platform calls for reliable hospital funding through a substantially revised hospital reform. Emergency care is to remain within reach and focus on patient well-being and high medical quality. Public, nonprofit and private operators are to continue side by side, but the party rejects profit maximization at patients' expense. Hospital planning should therefore be done in a structured way at the state level. The platform says the federal government has a duty to provide basic public services, so that municipalities and districts do not carry the hospitals alone.

The Free Voters regard vaccinations as an important preventive tool and want to strengthen counseling by family doctors. They reject compulsory vaccination because, in their view, it would damage trust in the health care system.

The Free Voters think vaccines are important. Family doctors should give even better advice about vaccines. The party is against forcing people to get vaccinated. It says forcing people would hurt their trust.

The platform describes vaccinations as an important preventive measure that has pushed back many diseases in Europe. To keep it that way, vaccine counseling in family doctors' offices is to be strengthened further. The party rejects any plans for compulsory vaccination, citing the loss of public trust it expects would follow.

The Free Voters want to guarantee care around pregnancy, birth and the postpartum period everywhere. They call for funding for maternity wards, support for birth centers and more university places for midwives. Couples seeking fertility treatment and pediatric practices are also to get more support.

The Free Voters want good care around birth. There should be maternity wards and midwives everywhere. Hospitals should get money for this. There should be more places to study midwifery. Couples who want a child should get money and advice.

Obstetric care is to be included again as primary care in the law on strengthening health care provision, and hospitals are to receive money to keep their maternity wards. Misguided incentives in hospital obstetrics are to be corrected, and performance indicators and case-based payments are to be supplemented with criteria for natural birth and patient satisfaction. Birth centers are to be supported and the number of university places in midwifery increased. The national health goal on health around birth is to be put into practice through an action plan. The platform also calls for better information on options during pregnancy, roundtables of the professionals involved, and counseling and financial help for fertility treatment. For pediatric practices, it criticizes fees that do not reflect the greater effort involved.

The Free Voters want all citizens to be required to state whether or not they are willing to donate organs. The declaration is to be made at a uniform occasion and stored in a central register. This is meant to increase donations and relieve relatives.

Many people are waiting for a donor organ. The Free Voters want a mandatory declaration. This means everyone must say whether they want to donate organs or not. This could happen when applying for an ID card. A doctor should give good information first.

According to the platform, about 8,500 people in Germany are waiting for an organ. It says willingness to donate is often there but, for lack of information, is not recorded on a donor card. The party sees the opt-out system, under which everyone counts as a donor unless they object, only as a temporary solution. Instead, everyone would have to make a declaration, for example when an ID card is issued. This is to be based on factual information from a family doctor or another treating physician, and the declaration is kept in a central register.

The Free Voters want seriously ill and dying people to be cared for with dignity. To that end, palliative medicine is to be strengthened, mobile teams supported and volunteer hospice workers given better financial support.

The Free Voters want good care for dying people. Palliative medicine should be strengthened. This is medicine that eases suffering when a cure is no longer possible. Mobile teams should get more support. Hospice volunteers should get more money.

In the party's view, death should no longer be a taboo in society. Mobile rehab teams and palliative care teams for children are to be supported. Further training completed by nursing staff is to be recognized. In physicians' specialty training in palliative medicine, greater flexibility must not lower quality; the platform considers exams and seminar attendance useful. The party backs expanding palliative consultation teams and funding them along the lines proposed by the German Association for Palliative Medicine.

The Free Voters regard addiction as an illness and want to expand prevention and support services. For alcohol, tobacco and medications they call for warning labels and a sales license for stores. In addition, people should be able to have drugs anonymously tested for their contents.

The Free Voters say addiction is an illness. Addicted people need help and are not criminals. There should be more education and more counseling. Stores should need a license to sell alcohol and tobacco. A license is a permit from the government.

The view of addiction as an illness is to apply to both substance and non-substance dependencies. Education is planned in schools and in adult education. Packages of legal, addictive substances are to carry warning labels. Stores, including supermarkets and gas stations, are to be able to obtain a license that can be revoked if they violate youth protection rules and ID checks. Support services include anonymous counseling by phone and in person as well as anonymous drug testing modeled on Portugal, which is meant to allow warnings and prevent deaths.

The Free Voters want to expand prevention, education and counseling on mental illness, especially for children and young people and in the workplace. Crisis services for mental health emergencies are to be available everywhere. No one should have to feel ashamed to seek help.

More and more people have mental illnesses. The Free Voters want more counseling and help. There should be crisis services everywhere. Companies should do more for their workers' mental health. No one should feel ashamed to get help.

The platform cites growing pressure at work and in social life as the cause of rising mental illness. Prevention and education as well as suicide prevention are to be expanded further, with particular attention to young people. Crisis services are to be set up nationwide. Companies are to take more preventive measures for their employees. The party also wants to help end the taboo around mental illness.