No priority for families | Economy

The Federal Ministry of Health is only extending the corona protective shield for clinics that offer mother or father-child cures until mid-June. This is an existential threat to the institutions, which are more important than ever right now.

Anne Schilling is looking for the right words to express her outrage. Over the phone you can hear the managing director of the mothers’ convalescence facility take a deep breath before saying: “Politicians keep claiming that families have priority in this crisis. You just don't notice it at all. It's just incredible." Schilling can hardly believe that the Federal Ministry of Health decided this week that it would only extend the federal rescue package for clinics that carry out mother-child or father-child cures by two weeks until April 15. June will be extended. It expired on May 31st. "This puts the clinics at serious risk," she says.

But a few steps back. In mother and father-child clinics, sick and exhausted parents and their youngsters can usually recover from everyday life for three weeks. The service is borne by those with statutory health insurance after approval by the statutory health insurance companies. The largest provider of this type of preventive care or rehabilitation is the non-profit foundation for mothers' recovery. In 2019, 47,000 mothers, 2,100 fathers and 70,000 children nationwide took part in their offers. There are no figures for 2020 yet. However, the expenditure statistics of the statutory health insurance companies (GKV) show that they spent 35 percent less on mother or father-child cures in the first Corona year. This is already an indication of how many fewer families used the option.

Clinics had to close

Which is not surprising. Most clinics had to close completely during the first lockdown in spring 2020, only in Brandenburg and Saxony did they remain open. The 73 clinics with which the mothers' convalescent work works were closed for an average of three months in 2020, says Schilling.

After a long struggle, they were included in the first lockdown under the federal government's rescue package for the health sector and thus received a cancellation fee of 60 percent for beds that remained free due to the pandemic. In other words, the clinics had to shoulder 40 percent of the failures on their own.

The umbrella expired at the end of September. Then came six weeks: nothing. “An existential problem for the clinics,” says Schilling. "To date, many have accumulated deficits in the six-digit range." The clinics are dependent on an occupancy rate of 95 percent in order to be able to manage with the daily rates that the health insurance companies pay clinics. "The fewest have reserves," says Schilling.

Mother and father-child cures used less often

In November there was a ray of hope: there was a new federal rescue package for the spa houses, but this only paid 50 percent instead of the previous 60 percent in cancellation fees empty beds paid. Shortly before Christmas, the Bundestag and Bundesrat also passed the Health Care Improvement Act (GPVG). What was recorded there with a view to mother or father-child measures deeply annoys Schilling. The legislature called on the health insurance companies to negotiate with the clinics about increasing the remuneration due to pandemic-related problems - and to include the six weeks without a rescue package in October and November. "But politicians should have ensured that there was a uniform nationwide framework for these negotiations," says Schilling. Because the statutory health insurance companies refused to negotiate this framework at federal level. And even at the state level - at which each clinic now has to speak individually with the health insurers - they only made one-sided offers with no options for negotiation, Schilling complains.

Application

The first point of contact for parents who want to apply for a cure is their family doctor. You must certify that you are in need of a cure. As a rule, the cash register approves the application. You can appeal against a rejection. The health insurance companies recommend clinics to the patients. However, they also have a right to wish and vote – they should name their preferred clinic in a short explanatory letter when they apply. The health insurance covers the costs. Employers have to take time off work, vacation is not necessary. Schools usually release children for the time of the cure after application. Children are then taught in the clinic. The clinics accept children up to the age of twelve, in exceptional cases up to the age of fourteen. Parents can get help with the application from the counseling centers of the mothers' convalescent work. nl

Higher daily rates, compensation payments for additional staff costs, for example because corona tests have to be carried out regularly and more therapists are needed because of smaller groups - so far every clinic has had to discuss this with the health insurance companies itself. In other words: you will continue to receive 50 percent cancellation fees from the federal protection umbrella and eight euros per person hygiene surcharge, everything else is a matter for negotiation with each individual clinic and health insurance fund. "Mother and father-child cures are the only health insurance measure for families and accounted for just 0.18 percent of health insurance expenditure in 2019. So it's really not a big item in the coffers' budget," says Schilling.

And now this week's news: The Federal Ministry of Health will continue to pay the default payments of 50 percent for empty beds for just two more weeks. Reason: The incidences are falling. After that, the clinics are largely on their own again.

Insecure parents, unvaccinated children

If they have to continue to comply with the hygiene rules, they cannot drive at full speed. “Our clinics currently have an occupancy rate of around 80 percent. But I also know houses that can only be booked with 60 or 70 percent. It depends on the spatial conditions," says Sonja Borzel, board member in the AWO district association of Upper and Middle Franconia and responsible for two mother-child clinics there. “We have the people with us who are the least vaccinated. After all, children cannot be vaccinated – and many mothers do not belong to any priority group.”

Last year, many mothers and fathers also canceled their cures at very short notice, so that subsequent bookings were no longer possible. The parents were unsure, they were afraid of infecting someone in the family after the cure. Or the schools would finally have been open for a few weeks again. "Some parents thought: We can't go to a spa now," says Borzel. Schilling says some clinics had up to 40 percent short-term cancellations last year.

For many parents, there is also the question of whether it is possible to recover in a clinic under the Corona rules. Of course there are restrictions, says Borzel about the clinics she is responsible for. For example, there is an FFP2 mask requirement in all public spaces. The number of participants in many therapy and sports groups is limited – but there are more offers. Eating is done in shifts, whereby only two families are allowed to sit at a table and the seating arrangement must also be observed throughout the cure. And swimming pools and saunas in the clinics are closed.

Only a limited offer due to the corona pandemic

"Nevertheless, the feedback from the patients is that they can recover very well overall. That it's just good to get away from it all," says Borzel. The children also thrived. "We notice that they have a great need for contacts, that they really like going to the groups," she says. Since some of the usual sports and therapy offers could not be offered because of Corona, the clinics would also place a strong focus on strengthening the parent-child relationship. Because: The families seemed to be significantly more stressed by the pandemic than before. "The mothers are even more stressed and exhausted than usual, even more than before they report problems in their partnership, and the children are tired too," says Borzel.

Some clinics still have vacancies for the summer, but most are fully booked until autumn or even winter. Because many mothers and fathers want to catch up on cures that were canceled in 2020. And many more are likely to feel mature after all the hardships of the pandemic. "We expect demand to increase significantly," says Schilling. It is to be hoped that all clinics will survive the pandemic in order to be able to cover this demand to some extent.