study
The federal government has no legislative competence for hospitals
A nurse pushes a hospital bed down a hallway. photo
© Marijan Murat/dpa
Many hospitals in Germany suffer from tight cash registers. But the federal government’s reform plans are only making hesitant progress. A new report draws clear red lines for further negotiations.
According to a study, the government commission’s proposals for hospital reform violate the legislative powers of the federal states enshrined in the constitution.
“The Basic Law does not provide for legislative competence of the federal government either for the hospital system in general or for hospital planning in particular,” says the 144-page legal opinion, which is to be presented in Berlin today. The author of the study is Ferdinand Wollenschläger, Chair of Public Law, European Law and Public Commercial Law at the University of Augsburg.
The elaboration was commissioned by the three union-led health ministries in Bavaria, North Rhine-Westphalia and Schleswig-Holstein. It was to examine the constitutionality of the expert proposals presented by the 17-member government commission on hospital reform.
According to the report, even after the reform, the federal states must 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.
Fear of collapse in hospital care
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.
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.