health care
Opinion: Federal government without legislative competence for clinics
Several federal states complain that the federal government is exceeding its competencies with the reform plans for the hospital system. photo
© Patrick Seeger/dpa
Many clinics in Germany are in financial difficulties. The federal government’s reform plans, which are intended to take countermeasures, are making sluggish progress. A new report draws red lines for negotiations with the federal states.
According to an expert opinion, the proposals of a government commission of the federal government for hospital reform violate the legislative competence of the federal states anchored in the constitution.
“The Basic Law does not provide for federal legislative competence either for the hospital system in general or for hospital planning in particular,” says the 144-page legal opinion that was presented in Berlin. It was commissioned by the three Union-led health ministries in Bavaria, North Rhine-Westphalia and Schleswig-Holstein.
Federal Health Minister Karl Lauterbach called it right to also analyze the legal aspects. However, the report deals with outdated reform plans and is not confirmed by other experts. “The discussion is now much further,” said the SPD politician. The urgently needed reform will be worked out together with the federal states. “The usual expert dispute must not and will not prolong hospital deaths.”
Violation of the Basic Law?
The author of the country report is Ferdinand Wollenschläger, Professor of Public Law, European Law and Public Commercial Law in Augsburg. He should examine the constitutionality of the experts’ proposals. According to his study, even after the reform, the federal states must still have considerable leeway for the hospitals. In short, the federal government should not make any regulations that affect the hospital structure of a federal state.
Bavaria’s Health Minister Klaus Holetschek (CSU) said: “The report shows that the proposals of the government commission are not in line with the Basic Law.” North Rhine-Westphalia’s Minister Karl-Josef Laumann (CDU) emphasized: “The report shows where the federal government’s reforms are limited by the planning sovereignty of the federal states.” Schleswig-Holstein’s head of department, Kerstin von der Decken (CDU), said: “Reforming hospital financing is important – especially in order to put the necessary care in the area on a secure footing in the long term.” According to the current status, however, she would also make specifications for hospital planning and thus massively intervene in the planning sovereignty of the federal states, criticized the CDU politician.
Concept provides for a new compensation system
The concept presented by the expert commission in December is the basis on which the legislative plans are to be based. In federal-state consultations, however, some other priorities have already become clear. In essence, the remuneration system is to be changed with flat rates for treatment cases in order to free clinics from economic pressure. In order not to be dependent on more and more cases, they should get a larger share just for the provision of services. The focus is also on classifying the clinic network into three levels of care and financing them accordingly – from basic care close to home to a second level with other offers up to maximum care providers such as university clinics.
The Greens health expert Janosch Dahmen said it was good that the countries had their special responsibility and competence for the clinics examined again with reports. Many houses are now ill themselves because unfortunately the federal states have not taken any effective precautions in the past. A “broken clinic infrastructure” at too many locations is no longer just a problem for profitability, said the member of the Bundestag of the German Press Agency. “It also means that the quality of patient care suffers more and more.” The reform will give the countries effective control instruments. It is the primary task of the federal government to pay attention to the cost-effectiveness and quality of social insurance, i.e. also the expenditure of the statutory health insurance companies to finance hospital treatments.
Critics of the reform plans fear that emergency care and regular inpatient care will not be able to be maintained in many hospitals. Bavaria already presented a study in February, according to which every eighth hospital in the Free State is at risk. The municipalities had also repeatedly warned of a collapse in hospital care.