Hospital Reform Progresses Amidst Challenges
The federal and state governments have taken significant strides in hospital reform discussions, with a revised draft set to be presented within the week. Federal Health Minister Karl Lauterbach (SPD) announced this following joint consultations in Berlin, highlighting that the upcoming draft will address key points of criticism.
The next coordination meeting is scheduled for early January, aiming to prepare a draft bill for the planned law. The states have confirmed their commitment to collaborate on the reform, with Lauterbach emphasizing the urgent need for action due to the financial straits faced by many clinics.
The pressures on hospitals are substantial, and there's a general consensus that swift and urgent reform is necessary. Lauterbach referred to the reform as a "revolution," stating that both sides managed to avoid disagreements, furthering their commitment to work together.
Key aspects of the reform include altering the compensation system for hospitals through flat rates for treatment cases, eliminating financial pressure to treat more patients. The new system will allocate 60% of remuneration based on service provision alone, with health insurance funds providing more precise definitions for financing service groups. This change is expected to support uniform quality standards and reduce financial strain.
Initially, the reform aimed to take effect on January 1, 2024; however, Lauterbach has revealed that entry into law has been postponed. Although implementation steps for 2025 and 2026 are still on track, the delay signifies ongoing efforts to negotiate critical aspects of the reform.
Criticisms from the federal states led to discussions on the effects of the reform on individual states and the reduction of bureaucracy, along with possible exemptions if specific quality requirements couldn't be met immediately. The goal remains to implement sustainable and flexible solutions according to regional needs while ensuring hospital survival, particularly in rural areas.
Revised Payment Systems and Service Groups
Central components of the revised hospital remuneration system include service groups, each representing specific areas of hospital specialization:
- Service groups (Leistungsgruppen) will be implemented across the industry, allowing hospitals to focus on their core competencies with the necessary equipment, staff, and expertise to provide superior care.
- A readiness payment (Vorhaltevergütung) will ensure hospitals receive 60% of their funding for maintaining essential services and infrastructure, with the remaining 40% tied to actual treatment volumes.
- The revised system will provide more significant value to patients, as they will need to travel for specialized care but receive higher quality treatment and improved outcomes in return.
- Rural hospitals will receive additional subsidies and permanent exemptions, aiming to preserve local access to care by integrating inpatient, outpatient, and nursing facilities (Level 1i hospitals).
- A €25 billion transformation fund, active from 2026 through 2035, will support hospital modernization, helping maintain financial stability and increase overall efficiency within the healthcare system.
By implementing these changes, the hospital reform aims to alleviate financial pressures on hospitals, prioritize quality patient care over volume, and create a more sustainable healthcare system that better meets the needs of its citizens, especially in rural areas.
