Lauterbach’s hospital reform: countries form the resistance – politics

As Federal Minister of Health you have more pleasant and less pleasant appointments. The annual visit to the German Hospital Society (DKG) probably falls into the strenuous category, because the hospital lobbyists are traditionally not particularly shy when it comes to submitting their wishes and complaints to politicians. One can therefore assume that Karl Lauterbach (SPD) did not expect a relaxed appointment when he paid his respects to the DKG at their “hospital summit” on Monday. And yet what he then heard must have been a nasty surprise for the Federal Minister of Health. Because there were also representatives of the countries on site – and they announced massive resistance to Lauterbach’s planned hospital reform.

For example, North Rhine-Westphalia’s Health Minister Karl-Josef Laumann (CDU) let it be known that it was crucial that the sovereignty over hospital planning remained with the federal states. If that is not the case, the hospital reform will not come. “I don’t think that the goal in Germany can be that the hospitals all have the same structure from Brandenburg to Passau,” says Laumann. “They will have to get used to that in Berlin, no matter who it is.”

“We are not the vicarious agents”

Lauterbach’s plans actually envisage a Germany-wide standardization of the hospital landscape. They are based on the draft of a government commission that wants to divide the clinics into different service levels and set fixed quality standards.

Brandenburg’s Health Minister Ursula Nonnemacher (Greens) was also critical. “There can’t be an axiom that the federal government stipulates: you states only have to do what is specified in terms of level assignment and performance group assignment. We’re not the vicarious agents.” Nonnemacher made it clear that he wanted to defend the responsibility of the federal states for hospital planning: “If we have planning sovereignty, we must also be allowed to exercise it.”

Emergency hospital: Pandemic and inflation have brought many hospitals into great financial difficulties.

(Photo: Leonhard Simon)

Cornerstones for legislative proposal in summer

In fact, hospital planning is the responsibility of the federal states – the plans of Lauterbach’s government commission did not initially take this into account. However, the federal states are involved in the reform process and are part of the working groups that are to work out the cornerstones of a legislative proposal for hospital reform by the summer.

Lauterbach has made a noticeable effort to win the favor of the federal states in the past few months, after his solo efforts in corona policy in particular had caused a lot of resentment among the state governments. In the case of the hospital reform, he initially seemed to be able to do this better, with state representatives repeatedly commenting positively on the joint work process. In the meantime, however, the mood seems to have changed.

It had already become known over the weekend that three states led by the Union – Bavaria, North Rhine-Westphalia and Schleswig-Holstein – had commissioned an expert opinion to examine whether Lauterbach’s reform plans are constitutional at all. The assessment by Ferdinand Wollenschläger, a legal scholar at the University of Augsburg, should be available in the spring. It could also bring clarity to the question of whether the law on hospital reform must also be passed by the Bundesrat, i.e. the state representatives.

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