Status: 03/12/2023 2:25 p.m
Bavaria, North Rhine-Westphalia and Schleswig-Holstein have commissioned a legal opinion. They want to have the constitutionality of the planned hospital reform checked. This intensifies the conflict with Health Minister Lauterbach.
North Rhine-Westphalia, Bavaria and Schleswig-Holstein are having the federal government’s hospital reform plans checked for constitutionality. The three health ministers of the federal states commissioned a legal opinion from the legal scholar Ferdinand Wollenschläger from the University of Augsburg, as announced by the NRW Ministry of Health in Düsseldorf. Results are expected this spring.
This intensifies the dispute with Health Minister Karl Lauterbach (SPD), who warned the federal states against going it alone with a hospital reform. On Tuesday in Düsseldorf he told his NRW colleague Karl-Josef Laumann (CDU) that if he went down this path, there would be no money from the federal government.
Expert opinion is intended to show the limits of the reform
“The report is intended to clarify where the federal government is limited in the implementation of its hospital financing reform,” said Laumann, explaining this step. He accused Lauterbach of not wanting to negotiate and decide on an equal footing with the federal states, contrary to previous promises. In addition, Laumann emphasized that the federal states “should not become the pure implementation authority of the Federal Minister of Health in the hospital sector”. NRW could bring the expertise of practitioners to the process who have been implementing a state hospital reform for three years.
Bavaria’s Health Minister Klaus Holetschek (CSU) emphasized: “Hospital planning is a matter for the federal states.” The report is intended to examine whether the federal government is still acting within the scope of its competence for the economic security of the clinics through mandatory structural requirements for care levels and service groups or instead “regulates” into the hospital planning of the federal states.
Schleswig-Holstein’s Minister of Health and Justice, Kerstin von der Decken (CDU), criticized that the structural changes planned by the federal government “encroach massively on hospital planning in the federal states and have significant cost consequences”. With the report, one also wants to contribute to “opening perspectives for a legally secure basis for the necessary reform. This aspect is neglected on the part of the federal government.”
“De-economization” of the hospital system
According to Lauterbach, the core of the planned reform, which is based on proposals from an expert commission and for which key points are to be presented in the summer, is a “de-economization” of the hospital system. The previous system of case flat rates is to be largely abolished. In the future, it is also planned that small hospitals will concentrate on basic care, while more complex interventions will primarily take place in large, correspondingly specialized clinics.
The Government Commission proposes that the newly introduced upfront fee for clinics should only be paid for services that the hospital in question is intended to provide by assigning a corresponding “level” and the required “service group”. In addition, the hospital must meet the minimum requirements associated with the level and service group.
According to the Bavarian Minister Holetschek, this recommendation goes “far beyond what is constitutionally permissible”.
Lauterbach had recently campaigned for the cooperation of the federal states. In his view, a hospital reform is only possible with Germany-wide uniform criteria and country-independent standards. In some federal states, it is feared that a nationwide hospital reform will jeopardize care in rural areas in particular.