Health care: Federal Council clears the way for hospital reform

The path is clear for a fundamental reorganization of hospitals in Germany in the coming years. The Federal Council allowed the controversial hospital reform to pass, which the traffic light coalition in the Bundestag had decided on. Despite criticism from several states, an appeal to the joint mediation committee with the Bundestag did not receive the necessary majority. Health Minister Karl Lauterbach (SPD) spoke of a “good day for patients” whose care, for example in the case of cancer, will improve. In the governments of Thuringia and Brandenburg, open conflicts emerged in the struggle over voting behavior in the Federal Council.

The reform, which has been prepared for almost two years, can now be implemented gradually. Lauterbach said that the hospital landscape would fundamentally change over the next 20 years: “And for the better.” The main goal is to reduce the financial pressure on the currently 1,700 clinics nationwide. “We will get more specialization,” said the minister. “At the same time, we will see that the small rural hospitals can make a living from what they do particularly well.”

New compensation system planned

Essentially, the current remuneration with flat rates for treatment cases is to be changed. In the future, clinics should receive 60 percent of the remuneration simply for providing certain offers. This is intended to eliminate incentives for more and more cases and sometimes medically suboptimal interventions. The basis for financing by the health insurance companies should be new “performance groups”. They are intended to describe clinic treatments in more detail and ensure uniform nationwide quality standards – for example in terms of specialist staff or treatment experience. A “transformation fund” worth billions is also to come.

Lauterbach warned against watering down the reform

There was a controversial debate in the Federal Council before the vote. Lauterbach appealed to the states to let the law pass. When it comes to possible changes in the Mediation Committee, one has to be honest: this would have been about the core of the reform. If such dilutions were made, the reform would no longer be needed. Specifically, Lauterbach defended the requirement that each service group must have at least three specialists. That was “non-negotiable” for him.

Criticism and support from several countries

North Rhine-Westphalia’s Health Minister Karl-Josef Laumann (CDU), however, warned that the requirements for specialists in rural regions are currently simply not achievable. What is needed is “more legroom” for the states when it comes to implementation. Baden-Württemberg’s federal representative, Rudi Hoogvliet (Greens), criticized the fact that the consequences of the reform could not be seriously assessed. A mediation procedure should neither delay nor prevent the project. The Rhineland-Palatinate Health Minister Clemens Hoch (SPD) promoted the reform. Their short-term financial effects would also be needed.

Uproar in two countries

Immediately after the meeting, internal disputes escalated in two state governments. In the vote, in which the states were called individually, Thuringia’s vote was not counted because it was inconsistent, as Federal Council President Anke Rehlinger (SPD) noted. First, Head of the State Chancellery Benjamin-Immanuel Hoff (Left) voted in favor of the mediation committee, and immediately afterwards Economics Minister Wolfgang Tiefensee (SPD) objected. Brandenburg’s Health Minister Ursula Nonnemacher was dismissed at short notice by Prime Minister Dietmar Woidke (SPD) – she received the written dismissal in the hallway of the Federal Council, as the Green politician later announced. According to her own statements, she wanted to abstain from the vote. The country then voted in favor of the mediation committee.

The law should take effect in several years

The law is now scheduled to come into force on January 1, 2025. The new structure will only be implemented over several years until 2029. The network of 1,700 hospitals is therefore likely to become smaller. Many hospitals have long been struggling with financial difficulties, unoccupied beds and a lack of staff. The federal states and the clinic industry had therefore also called for bridging financing until the reform took effect.

Shared response from clinics, health insurance companies and patient representatives

With a view to the federal election on February 23rd, the German Hospital Association demanded that a new government must immediately correct the hospital reform. The law will not improve supply, but will often worsen and disappear completely in some regions. The Association of University Hospitals, on the other hand, welcomed the fact that better quality and more efficiency were now on the way.

The German Foundation for Patient Protection regretted a missed opportunity to reach a good compromise. “Medical care in the structurally poor regions is now at stake,” said board member Eugen Brysch.

The head of the Techniker Krankenkasse, Jens Baas, welcomed the fact that the states have paved the way for more quality and specialization. What is now important is further regulations at the federal level and clever hospital planning in the states. For the Allgemeine Ortskrankenkassen (AOK), association head Carola Reimann said that despite all the shortcomings, the law is a solid basis for improving the quality of treatment and for the financial security of clinics that are necessary for the needs.