Hospital summit: headwind for Lauterbach’s reform plans

Status: 03/13/2023 7:06 p.m

Federal Health Minister Lauterbach wants to fundamentally redesign the German hospital system. In order for that to succeed, he has to get the countries on board. But they insist on their skills.

By Nadine Bader, ARD Capital Studio

Federal Health Minister Karl Lauterbach’s seat is still empty when the hospital summit opens. Health Minister Karl-Josef Laumann from North Rhine-Westphalia is also not there when the chairman of the German Hospital Society (DKG) Gerald Gass opens the event. Gass jokes that the two probably still have something to talk about. An allusion to the fact that the signs between Lauterbach and three countries led by the Union are currently on confrontation with plans for a far-reaching reform of the hospital landscape.

Lauterbach has probably already priced in the protests from the federal states in his project. It is the largest reform project in the hospital landscape in 20 years. Lauterbach wants to fundamentally redesign the system. Experts largely agree that this is necessary. Because the hospital landscape is considered expensive and inefficient. In the future, clinics should receive more money for their fixed costs, such as the provision of staff, technology or emergency rooms. On the other hand, the case-based flat rates should be given less importance in the billing. The clinic network is to be divided into three levels of care and financed accordingly.

Laumann is actually regarded as a confidante of Lauterbach

At the weekend, however, Bavaria, North Rhine-Westphalia and Schleswig-Holstein announced that they would have the planned hospital reform checked for its constitutionality. They fear hospital closures and encroachments on their state competences, because hospital planning is a state matter. Cross shots from Bavaria were certainly to be expected. The Bavarian Health Minister Klaus Holetschek (CSU) has long since made a name for himself among observers as a vocal opponent of Lauterbach, who never misses an opportunity to protest.

Laumann, on the other hand, is actually considered a confidante of Lauterbach when it comes to hospital reform. Both have known each other for a long time and appreciate each other. Both want to advance the reform. But last week there was a scandal between the two. Lauterbach had warned Laumann not to push ahead with his state-owned plans to restructure the hospital landscape. Then there will be no money from the federal government. The background is that Laumann has been working on a reform in North Rhine-Westphalia for three years. This differs in important details from the plans that Lauterbach wants to implement nationwide.

Built-up frustration in the clinics

It was already clear in advance that the Federal Health Minister’s visit to the hospital summit would not be a home game. Lauterbach’s hospital reform plans have been heating up tempers in the industry for months. A lot of frustration has also built up at the German Hospital Society. Its chairman Gass had already criticized in advance that the promised energy aid could only be used by very few hospitals due to unfavorable detailed regulations. The DKG has been warning of a “hospital insolvency wave” for months.

It is therefore not surprising that Gass quickly focused on the subject of finances when Lauterbach took his seat about eight minutes late. Gass addresses his request directly to the minister. Lauterbach should approach Federal Finance Minister Christian Lindner. So far, Lauterbach has held back with specific financial demands for the planned reform – probably because he knows that Lindner wants to keep the money together. “Discuss a large investment fund with your colleagues in the federal states,” demands von Lauterbach. Ten billion euros per year are necessary to modernize locations, finance hospital mergers and also initiate closures.

Just a little fight?

Frustration and financial difficulties in the clinics on the one hand, anger in the federal states because of the hospital reform on the other hand – it is a difficult situation when Lauterbach takes the podium. He admits that the situation in the hospitals has “never been as difficult as it is now”. He cites a lack of staff, high costs due to inflation and a lack of investment as reasons – a dig at countries, because they have not fulfilled their obligation to provide sufficient money for the investment costs of the clinics for years. According to the Association of Statutory Health Insurance Funds (GKV), the investment rate of the federal states was still 25 percent in 1972 and fell for years to around three percent in 2020. The level of investment differs from state to state.

Above all, however, Lauterbach wants to calm the waves by getting the federal states on board with the hospital reform. Lauterbach knows how important the Minister of Health from North Rhine-Westphalia could still be for him in this process. Their little argument won’t burden the joint work, Lauterbach jokes towards Laumann. He needs the minister from the large Union-led area country at his side. The well-being of the patients is obvious with the planned reform, explains Lauterbach. The quality of treatment will improve. Difficult interventions, for example in the field of oncology, should only be carried out in certified centers in the future. The supply in the country will also be secured. Planning sovereignty remains with the federal states.

States do not want a “federal template”

Lauterbach’s charm offensive in the direction of the countries only works in part. In the discussion that followed, NRW Minister of Health Laumann once again made it clear that there would be no reform without the approval of the federal states in the Bundesrat. He cannot allow a “federal template” to be placed over the states. Brandenburg’s Health Minister Ursula Nonnemacher (Greens) agrees that the federal states must retain their sovereignty in planning clinics. At the same time, both emphasize that a concrete draft law must be presented by the end of the year.

In the end, it will probably also depend on the extent to which agreement can be reached on country opening clauses, i.e. certain exceptions to address regional circumstances. There should be a total of six rounds of negotiations between the federal and state governments by the summer, and at least the key points for the reform should then be in place. “I’m an impulsive person, and so is Mr. Lauterbach,” says Laumann in a more forgiving manner. He does not want to overestimate the recent disagreement and wants to continue working in Berlin to ensure that the reform is successful. Lauterbach will probably take him at his word.

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