Hospital Reform Face considerable obstacles: Optimism wanes
Just days ahead of the joint federal-state government meeting on hospital reform, Bavaria's pessimism casts a shadow over swift agreement. Federal Health Minister Karl Lauterbach (SPD) disregards state demands in the new draft bill from the Federal Ministry of Health, as Bavaria's Health Minister Judith Gerlach (CSU) asserted to DPA in Munich on Wednesday. The conference to amend the law is scheduled in Berlin on Thursday.
"In the draft bill, Lauterbach persistently ignores central demands of the federal states," stated Gerlac. Modest improvements to the bill are not enough, she argues, and such sentiments do not bode well for the federal-state working group meeting.
"Hospital reform should not jeopardize inpatient care," Gerlach emphasized, voicing Bavaria's insistence on substantial amendments to the reform agenda. "We will persistently oppose these encroachments on the hospital planning powers of the federal states," she declared, using her full strength to contest these moves.
"The hospital reform can only succeed if the federal government tackles the structural financial deficits of the hospitals," said Gerlach, arguing that announced short-term measures fall short of the mark by far.
In summer, a consensus on the hospital reorganization's fundamental outline emerged among the federal and state governments. Legislation preparation for the revision has been ongoing for several weeks.
Reform proposals envision a shift to a flat-rate payment system for treatment cases to relieve financial pressure on hospitals to process an increasing number of cases. Hospitals will receive 60% of the remuneration for services, and financing via the health insurance funds will be based on more precisely defined groups of hospital services - ensuring uniform quality standards.
Despite Gerlach's criticisms, the federal and state health ministers plan to gather in Berlin to discuss the hospital reform legislation amendment the following day. However, Bavaria's persistent demand for significant corrections to the reform plans raises concerns about the future of inpatient care in hospitals.
Enrichment Insights:
- Financial Pressure and Funding Model: The reform aims to ease financial strain on hospitals by creating a EUR50 billion transformation fund, shared equally by federal and state contributions, with health insurance funds allocating EUR2.5 billion annually for the next decade.
- Impact on Smaller Hospitals: Smaller hospitals struggle to acquire necessary equipment, potentially affecting care standards. Facing additional financial responsibilities, they may close or merge with larger institutions.
- Criticism from Health Insurers and Social Welfare Organizations: The German peak association of health insurers plans legal action against the reform, arguing that health insurance funds should not bear this population-at-large-benefiting financial responsibility. Legal challenges from VdK, a social welfare organization, express similar concerns.
- Kliniksterben (Hospital Closures): The proposed reform may result in hospital closures across Germany, including Bavaria, where three hospitals shut down in 2024. The potential for widespread hospital closures and threats to the universal clinical care structure invite legal challenges from advocacy groups like the Bündnis Klinikrettung.
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Enrichment Data:
- The financial consequences of the reform have been a matter of debate, with health insurance funds carrying a significant share of the burden. In 2023, health insurers reported a deficit of EUR1.9 billion, while preliminary 2024 figures suggest a shortfall of EUR3.7 billion in the first three quarters.
- Smaller hospitals run the risk of declining care standards due to insufficient resources and funding for modernization. This includes the acquisition of new equipment and maintenance of up-to-date facilities.
- Health insurers and social welfare organizations have expressed dissatisfaction with the reform's financial implications and potential long-term consequences. The peak association of health insurers and social welfare organization VdK have both pledged to explore legal challenges against the proposed reform.
- Hospital closures have already begun in some regions of Germany, like Bavaria, where three hospitals closed in 2024. Critics believe the reform will further drive hospital closures and negatively impact universal clinical care. This unrest has prompted advocacy groups like the Bündnis Klinikrettung to challenge the reform proposal in court.
- Judith Gerlach's concerns include the negative impacts on inpatient care, the financial burdens on health insurance funds, and the potential for hospital closures. Without addressing these issues, the future of healthcare accessibility and quality remains uncertain.
