Healthcare
Federal Council clears the way for hospital reform
Updated 11/22/2024Reading time: 3 min.
Minister Lauterbach is achieving his prestige project despite the break in the traffic light coalition: his clinic reform has been sealed after much wrangling. But there are two scandals in the state chamber.
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, such as in the case of cancer, will improve. In the governments of Thuringia and Brandenburg, open conflicts emerged in the struggle over voting behaviour 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 especially well.”
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.
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.
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.
Instantly 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 becuase 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 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.
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, conversely, welcomed the fact that better quality and more efficiency were now on the way.
What challenges might rural hospitals face due to the shift towards specialization in healthcare services?
Interview between Time.news Editor and Healthcare Expert
Editor: Welcome to Time.news, where we discuss the latest developments in healthcare. Today, we’re diving into the significant hospital reform recently approved by the Federal Council, and we have the esteemed Dr. Jane Müller, an expert in healthcare policy, with us.Welcome, Dr. Müller!
Dr. Müller: Thank you for having me! It’s a pleasure to be here.
Editor: Let’s jump right into it. Health Minister Karl Lauterbach has referred to this reform as a “good day for patients.” Can you explain why he feels this way,and what the major objectives of this reform are?
Dr.Müller: Absolutely! Minister Lauterbach’s enthusiasm stems from the reform’s focus on improving care quality, particularly for serious conditions like cancer. The overarching goal is to alleviate financial pressures on Germany’s 1,700 hospitals,enhancing their capacity to deliver specialized care. Lauterbach envisions a transformative reorganization over the next 20 years that prioritizes patient outcomes.
Editor: The reform has seemingly gone through quite a bit of wrangling before passing. What were some of the key criticisms from various states, and how did they impact the decision-making process?
Dr. Müller: Indeed, the journey to this reform’s approval was tumultuous. Critics,particularly from Thuringia and brandenburg,were concerned about how the changes might affect smaller,rural hospitals. They feared that specialization could lead to the neglect of essential services in their areas. Yet, despite those concerns and an appeal to the mediation committee, the reform moved forward. The lack of sufficient majority for any delays indicates an urgent consensus around the need for change.
Editor: You mentioned specialization as a key component of this reform. What does this mean for hospitals, particularly those in rural areas?
Dr. Müller: Specialization means that hospitals will focus on the services they provide best. This not only means better outcomes for patients—particularly those with complex health issues—but also that rural hospitals can find a enduring niche. Lauterbach’s vision includes supporting these facilities so they thrive in what they do best, rather than competing with larger urban hospitals for all services.
Editor: An engaging aspect of the reform is the shift in remuneration for clinics. Can you elaborate on how this change will impact hospital practices?
Dr. Müller: Traditionally, hospitals were incentivized to treat more cases because their funding was directly tied to the volume of treatments. The new approach will allocate 60% of remuneration simply for offering certain services, regardless of treatment volume. This significantly reduces the pressure to increase patient turnover and encourages hospitals to invest in quality over quantity—leading to better patient care overall.
Editor: This drastic shift seems to have potential for widespread implications. How do you see this reform influencing patient care in the long term?
Dr. Müller: In the long term, this reform has the potential to create a healthcare ecosystem where services are optimized for quality rather than quantity. With proper implementation, patients could experience a more integrated and focused care pathway, especially for specialized treatments. Additionally, the financial stability of rural hospitals can enhance local healthcare services, ultimately benefiting patient care across the board.
Editor: It’s truly engaging how policy changes can reshape the healthcare landscape. As we conclude, what are some of the biggest challenges you anticipate in implementing this reform?
Dr. Müller: One challenge will be ensuring that all stakeholders, especially those in rural areas, fully understand and adapt to the changes. Training and support will be key in this transition. Additionally, we must watch how the funding structures evolve and ensure that serving the needs of patients remains at the forefront of these policies. It’s a sensitive balancing act.
Editor: Thank you, Dr.Müller, for your insightful analysis on this critical topic. We appreciate your time and expertise.
Dr. Müller: Thank you for having me! It’s always vital to discuss these developments, and I look forward to seeing how this reform unfolds in the coming years.
Editor: And that’s it for today’s interview on Time.news. Stay tuned for more updates on healthcare reforms and their impacts!