Cabinet initiates hospital reform

It is the central project of Health Minister Lauterbach. The cabinet has now approved his hospital reform. It provides for a departure from the previously applicable flat rates. Criticism comes from federal states and health insurance companies.

The controversial hospital reform has cleared the first hurdle: the Federal Cabinet passed the draft law from Federal Health Minister Karl Lauterbach. With the reform, Lauterbach wants to fundamentally change the financing, organization and range of services of the approximately 1,900 hospitals in Germany.

A key goal is to improve the quality of treatment by no longer allowing every clinic to do everything. Instead, the minimum structures of medical experience, personnel and technology necessary for a service must be demonstrated. Only then will the clinic be assigned a corresponding service group and be allowed to bill for the service. This should reduce the number of hospitals and ensure more large clinics.

Moving away from flat rates per case

The reform is also intended to change the current remuneration with flat rates for treatment cases. The financing of hospitals is being changed in such a way that the clinics are freed from the financial pressure of having to treat more and more patients. In concrete terms, this means that in the future they will receive 60 percent of the remuneration simply for providing offers.

Lauterbach said that with the reform the government is pulling the emergency brake: “Without changing the structures of inpatient care, there is a risk of clinic insolvencies, poor treatment and long journeys.” The new regulations should ensure good inpatient treatment for everyone in an aging society. “We will therefore replace flat rates per case, which currently often determine medical action, with flat rates and quality specifications. Then the medical need determines the treatment, not the economy.”

Criticism from federal states and health insurance companies

There is a lot of criticism of the planned reform from the health insurance companies and the federal states. The states accuse the Federal Minister of Health of wanting to indirectly centralize hospital planning through the quality standards. But that is the responsibility of the federal states. They fear that gaps in supply will arise, particularly in rural regions.

A letter from the Conference of Health Ministers of the federal states states: The fact that “none of the states’ demands were included by the Federal Ministry of Health in the government draft” represents an “unusual process in every respect”. The “expertise and experience of 16 countries is left out”. leaving it was “a serious mistake”. The letter calls, among other things, for respecting the “planning sovereignty of the states that know the local conditions, population structure and needs.”

Health insurance companies fear massive additional expenses and premium increases. A transformation fund with a total volume of 50 billion euros calculated over ten years is to be set up for the reform. It should be financed half by the federal government and half by the states. However, the federal government wants to finance its share from the health insurance funds. The health insurance companies could sue against this. They argue that the organization of health care is a compulsory state task and the responsibility of taxpayers and not contributors.

The Federal Council no longer has to agree

However, Lauterbach no longer designed the law in such a way that it required approval in the Federal Council – the state chamber. The draft is now being discussed in the Bundestag. The law is scheduled to come into force at the beginning of 2025, with concrete implementation to follow step by step in the years thereafter.