Laboratory tests are an indispensable cross-sectional task in modern medicine. They are performed by specialists in laboratory medicine, but also by other medical professions. Laboratory diagnostics is the basis for two thirds of all clinical diagnoses. Laboratory diagnostics strengthen prevention by detecting diseases before typical symptoms occur. With objective and precise diagnostic values, it forms the basis for targeted therapy and enables treatment to be directly adapted to the respective healing success as part of therapy monitoring. In this way, treatment processes are individualized and optimized, resulting in an increase in both medical and economic effectiveness. The comprehensive benefits of laboratory diagnostics must be adequately remunerated. Appropriateness in this sense also means that remuneration should be value-based and thus more strongly oriented towards the output of diagnostics than towards the material costs of a product.
The remuneration of inpatient and outpatient laboratory services must also be calculated in such a way that they can be adequately provided as a medical service, even by smaller facilities and practices. At present, the remuneration system, particularly in the area of SHI-accredited physicians, is designed in a way that is rather hostile to laboratories. Laboratory remuneration in the EBM is based on flat-rate quotas. Groups of doctors who are allowed to bill for certain laboratory services with the permission of the Associations of Statutory Health Insurance Physicians are also subject to case value-based budgeting. The construct of the efficiency bonus rewards the non-provision of laboratory services. The efficiency bonus should be reduced and abolished in the long term. If it is to be accepted that the entire fee volume in SHI-accredited medical care requires certain control mechanisms, more intelligent approaches can be imagined for laboratory medical services. These should also take into account the extent to which efficiency gains can be achieved elsewhere in the medical service provision process by providing more laboratory diagnostics.
The reform of the scale of fees for doctors (GOÄ) remains on the health policy agenda for the coming years. One basis for this is the calculation of individual fees using transparent, comprehensible and representative data. It should be noted that the basic features of the GOÄ date back to the early 1980s and do not reflect the cost increases and technical progress that have occurred since then. The basic idea of promoting "talking medicine" is understandable. However, it justifies neither the reduction of laboratory fees nor the reallocation of funds from the laboratory to other areas. The categorization into speaking and technical disciplines of medicine is artificial and carries the risk of playing off medical professional groups against each other. This applies equally to the GOÄ and the EBM. Laboratory medicine speaks with measured values. Its key role is dramatically evident in the management of the pandemic and is of very specific value in other areas, e.g. the early detection of diseases.