Trust and resilience: two sides of the same coin

These two interdependent aspects are critical for health systems to rise to meet any challenges they face – how are they being integrated into German health policy?

During the Covid-19 pandemic, the world focused on various metrics to monitor the spread of the virus and health system capacities, such as the daily number of new confirmed cases, hospitalisation rates or the availability of beds in intensive care units. There are more aspects that are not so easy to measure, but are nevertheless crucial for a well-functioning health system.

One of these is trust. In times of crisis, trust in the health system reduces panic and the spread of misinformation. People are more likely to follow medical advice and adhere to treatment plans when they trust their healthcare providers and the system as a whole. Trust encourages people to take health issues seriously and seek medical help at an early stage, facilitating early diagnosis and effective treatment. Moreover, trust is essential for the success of public health campaigns, such as routine vaccinations or disease prevention programmes.

Resilience and reliability

What applies to trust also applies to resilience. Resilience, or the ability to adapt to challenges, is crucial for health systems. It allows health systems to adapt to crises such as pandemics or natural disasters, and also to challenges including demographic shifts or new technologies. Resilient health systems are sustainable in the long term due to efficient resource management. This is particularly important because even in times of scarce resources, resilient health systems are able to maintain service delivery and quality.

Trust and resilience are clearly interdependent aspects that support the effective functioning and sustainability of health systems. A resilient health system builds public trust by demonstrating reliability and effectiveness even in times of crises, and high levels of trust contribute to the resilience of the system, for example through cooperation and community support.

The German health system – as many other health systems – is currently facing major challenges. The increasing number of adults who are 65 years and older leads to a higher demand for medical services, chronic disease management and long-term care. In addition to the rising costs, we also face a shortage of doctors, nurses and other healthcare professionals, particularly in rural areas. And we need to catch up with other countries in the field of digital technologies.

One thing is clear: We cannot leave everything as it is. What we need is a general overhaul of the German healthcare system based on fact-based and clear political choices. Superficial cosmetic repairs are no longer sufficient. We need to delve deeper into the structures, which are inefficient as they are now. The departure of baby boomers from the labour market and their arrival in the waiting rooms of doctors’ surgeries and on the waiting lists of care facilities are forcing us to take action. Doctors’ surgeries are drowning in bureaucracy, hospital beds are empty, and more inpatient treatment is being provided for conditions that have long been a good outpatient service elsewhere.

Structural reforms

Several laws were passed recently in Germany with the aim of making our health system more sustainable, more efficient and more resilient against crises. What these major structural reforms all have in common is that they all have financially effective components in the medium and long term. They improve the quality of care, safeguard it and make it more efficient. In this way, unnecessary expenditure can be avoided.

For example, we are currently working very intensively on hospital reform to overcome the disadvantages of the expensive system of a flat rate per case. Volume incentives are to be reduced, unnecessary treatments prevented and, as a result, costs reduced in the medium to long term. With the already adopted Hospital Transparency Act as the first pillar of the reform, we want to significantly improve the quality and efficiency of the system. The act creates the foundation for the publication of the Federal Clinic Atlas with the aim of providing the public with a permanent, comprehensible and barrier-free overview of which hospital offers which services and of what quality.

Moreover, we have already started our race to catch up in the field of digitalisation. On account of its size, Germany has accumulated vast amounts of health data. But it is stored in separate silos, in individual cancer registries, hospitals, health insurance funds or genome databases. The first law, the Digital Act adopted in 2023, provides the basis to quickly tap into the potential of electronic patient records to support medical care and improve the quality of treatment. It is intended to make the benefits of digital innovation more tangible in routine clinical care. It also enables us to ensure that electronic patient records provide health data in a high-quality, structured form for data-driven patient care and for secondary health data use. Through the second law, the Act on Health Data Use, also adopted in 2023, we will facilitate data use, take initial steps in linking data holders – cancer registries and claims data – and enable user-friendly access to secondary health data for research and development. This is a real turning point in research, especially for developing artificial intelligence systems.

In all these measures we pursue the following goal: to ensure the best possible medical care for patients and further strengthen their trust in our health system. No single groundbreaking innovation will help us achieve this goal. Rather, we are dealing with complex structures that have grown over time and involve many stakeholders. That is what resilience is all about: the ability to adapt, recover and grow stronger. ▪