CSU-Landesgruppenchef Alexander Dobrindt has called for a stronger approach towards the states in the planned hospital reform. Health Minister Karl Lauterbach (SPD) must sit down with the states at the table on this central issue and not work against the states, Dobrindt said. He criticized the unbalanced nature of the reform, stating that it would lead to higher costs for contributors and a deterioration in rural areas. The Bundeskabinett had approved the legislation plans, aiming to reduce financial pressure on clinics and establish uniform quality rules by changing the current system of flat-rate reimbursements for treatment cases. Under the new system, hospitals would receive 60% of the reimbursement for offering specific services.
The basis of financing by health insurance funds would now be more precisely defined “performance groups,” which would describe clinic treatments more accurately and set minimum requirements. The states unanimously demand changes to the plans, but Lauterbach did not structure the law in a way that would require approval from the Bundesrat. The draft will now be debated in the Bundestag, with the law expected to come into effect in early 2025 and implementation to follow in the subsequent years. Bavaria plans to exert pressure through the Bundesrat to push for changes to the reform. The Bavarian Minister of Health, Judith Gerlach (CSU), mentioned the possibility of resorting to a conciliation committee if the demands of the states are not met, suggesting that a lawsuit is also an option.
The Union is concerned about potential higher health insurance contributions resulting from the reform. The CSU health expert, Stephan Pilsinger, estimated that this could lead to an additional 0.5 percentage point burden on contributors. To support the transition to the new structures, a “Transformation Fund” is proposed, which could receive up to 25 billion euros from the statutory health insurance funds from 2026 to 2035, provided that the states contribute an equal amount. Lauterbach emphasized that negotiations with the states are still ongoing and defended his decision not to dilute the reform beforehand. He stressed the importance of maintaining the quality of care while acknowledging ongoing negotiations with the states.
During the presentation of the plans, Lauterbach described it as both a revolution and a safety net. Without structural changes, there is a risk of hospital bankruptcies, subpar treatment, and long distances for patients, he explained. The Social Association of Germany criticized the proposal for the Transformation Fund to be solely funded by statutory health insurance and not also by private health insurance. Despite this concern, the association’s CEO, Michaela Engelmeier, believed the reform was heading in the right direction. The FDP aims to ensure that the reform is implemented with minimal bureaucracy, as stated by the party’s parliamentary leader, Christian Dürr.
The Chair of the Health Ministers Conference, Kerstin von der Decken (CDU) from Schleswig-Holstein, expressed dissatisfaction with the current outcome of the reform, highlighting concerns that it could lead to both improvements and setbacks, particularly for rural areas where small clinics may face closure. She noted that the law appeared to cater more to large providers in urban areas rather than rural regions. The Länder had supported the reform from the beginning but were not satisfied with the final result, she stated on ARD’s “Tagesthemen” program. If the law is enacted as is, it may not fully address the needs of all regions, resulting in disparities between urban and rural healthcare.
