The basic structure of the hospital reform is: Fewer clinics in metropolitan areas, but more specialized

The hospital landscape in Germany will change drastically in the coming years. There will be fewer hospitals, especially in urban areas, they will become more specialized and the quality of care will be better. This is what the planned hospital structure reform wants, the basic structure of which the federal and state governments were able to agree on yesterday. Federal Health Minister Karl Lauterbach (SPD) spoke of a “breakthrough”. It was agreed that future hospital planning would be based on so-called performance groups, which in turn are linked to nationwide quality criteria.

After the joint meeting, Hamburg’s health senator Melanie Schlotzhauer (SPD) and the state health ministers from NRW and Baden-Württemberg Karl-Josef Laumann (CDU) and Manfred Lucha (Greens) were optimistic that they would be able to present the key points for a law before the summer break. On the basis of this, a draft bill will then be drawn up during the parliamentary summer break. The announced goal is for the reform to come into force in January 2024.

3 level system is coming

And even if Schlotzhauer spoke of a “close and new quality of cooperation” and Lucha of a “great hour”, there are still a few open points in the reform debate. Above all, the question of the level classification. Lauterbach continues to adhere to the basic idea of ​​the Hospital Commission to divide hospitals into three different levels – from Level I, integrated care centers that provide basic care but no emergencies, to Level II hospitals, which offer a larger range of services including emergency care , up to level III houses, the maximum care including the university medicine.

The Federal Ministry of Health wants to allow the federal states that still reject the levels defined and specified by the federal government and instead want to decide on their own initiative whether to introduce or maintain them, “instead of an assignment to the uniform federal levels, to make an assignment to equivalent care levels”. At the federal level, however, level classifications are to be made. According to Lauterbach, there was no agreement on this issue yesterday either, one agreed, one disagreed.

More and more hospitals are going bankrupt

The fact that the state representatives were so positive yesterday is based on many concessions that Lauterbach has made to the states in the meantime. “The responsibilities of the federal and state governments are clearly defined, we don’t get in each other’s way,” said Lauterbach.

This reform must succeed.

Manfred LuchaHealth Minister of Baden-Württemberg (Greens)

Everyone involved wants to bring the reform to fruition, explained both Lauterbach and the current chairman of the
Conference of Health Ministers Lucha. The Greens politician said: “This reform must succeed.” Because in many places there is already a lack of staff and money, which is why existing structures can hardly be maintained. More and more hospitals are slipping into bankruptcy, sometimes wards can no longer be operated at all because there are no doctors and nurses. Not only the German Hospital Society, but also Lauterbach warns of an “uncontrolled
hospital deaths”.

Reduction of case flat rates planned

With the planned reform, the financing of the hospitals, which is often no longer adequate, is then to be changed – from pure financing via so-called case flat rates, which provide for a certain budget per treatment, to an addition of a provision flat rate, which rewards pure availability. In concrete terms, this is to be financed by reallocating the funds already available in the system. The previous case flat rates are to be lowered and the funds thus released are to be used to fund the hospitals.

Another sticking point in the struggle for reform remains the question of the allocation of performance groups. Which hospital is allowed to carry out liver surgery, which offer pediatric and adolescent surgery, where is obstetrics allowed to take place? The federal and state governments have already agreed in one of the last rounds that they want to be guided by the hospital reform in NRW, which is based on the allocation of a total of 64 service groups. Only hospitals that meet certain quality criteria are allowed to carry out appropriate treatments and interventions. “The modeling with our performance groups has shown that the system is consistent,” said Laumann. Further details are to be discussed at the next federal-state meeting on June 29th.