Berlin, March 6 – Germany’s comprehensive hospital reform, a subject of intense debate and negotiation since its initial passage in late 2024, is undergoing significant revisions. The federal government is set to approve further changes this Friday in the Bundestag, aiming to introduce greater flexibility in its local implementation. Health Minister Nina Warken (CDU) stated that the goal is to make the regulations more “practical,” while critics express concerns that these adjustments could dilute the reform’s central objectives.
What Does the Original Hospital Reform Entail?
The reform, enacted by the coalition of SPD, Greens, and FDP, was designed to alleviate financial pressures on hospitals and promote greater specialization for complex medical procedures. Former Minister Karl Lauterbach (SPD) famously described it as a “revolution.” The core of the reform involves transitioning to new “service groups” for billing purposes, which offer a more precise classification of medical treatments than traditional hospital departments. Each service group is assigned uniform quality standards regarding specialist personnel and equipment. This aims to ensure that procedures like cancer surgeries are performed in hospitals with specialized expertise.
Why Are These Changes Being Introduced Now?
The original reform was expected to lead to a reduction in the number of Germany’s 1,700 hospitals, encouraging specialization and cooperation rather than financially driven, unnecessary, or rare interventions. The federal states, responsible for hospital planning, voiced protests against the initial rigid framework. Consequently, the Union and SPD agreed in their coalition agreement to introduce amendments that would allow for more flexible implementation, particularly to safeguard basic and emergency care in rural areas.
Key Amendments to the Reform
The proposed changes include increased opportunities for cooperation and local exceptions. Federal states will gain more autonomy in assessing these needs, without being strictly bound by nationwide accessibility requirements. Exceptions allowing hospitals to offer a service group despite not meeting all quality criteria can be extended by up to three years, though the coalition emphasizes these will be limited to individual cases. Transition periods are also being extended, and changes to remuneration will take effect one year later than initially planned. Furthermore, the number of service groups will be reduced from 65 to 61.
Reactions to the Proposed Amendments
The National Association of Statutory Health Insurance Funds views the changes as a “viable compromise,” noting that immense pressure from states and hospitals was not fully conceded. Despite some softening, the reform still holds the potential to improve healthcare in the medium term. Green Party expert Janosch Dahmen, however, warned that the concentration of locations, beds, and services would be slowed down. He stressed that this concentration is a “central lever” for urgently needed improvements in efficiency and quality. The German Hospital Association welcomed the changes, stating that they provide a degree of planning security.
The Rationale Behind the Initial Reform
According to expert assessments, Germany has a comparatively high number of hospitals compared to neighboring countries. For years, the sector has faced persistent issues: financial difficulties, staff shortages, and, according to ministry data, approximately one-third of the 470,000 beds were recently unoccupied. The reform aims to achieve a controlled rather than uncontrolled restructuring of the hospital network. Financial pressures are also a significant factor, with statutory health insurance expenditures for hospitals projected to increase to 120 billion euros this year.
Further Regulations for Hospitals
Regarding a support fund for the restructuring of hospitals, the federal government is increasing its contribution to the states, providing 29 billion euros instead of 25 billion euros until 2035. The law also addresses the future of the controversial “Federal Hospital Atlas.” This comparison portal, launched directly by the ministry in 2024 to provide information on specific hospital services, will now be transferred to the joint federal committee of doctors, hospitals, and health insurance funds.
Additional Provisions in the Legislative Package
The legislative plans also encompass other areas. For appointments arranged via the nationwide service hotline 116 117, a maximum waiting period of three weeks will apply for radiologists, compared to the general four-week period. The justification for this is that X-rays are “in many cases a basic prerequisite for further medical treatment decisions and should therefore be carried out as soon as possible.”
Next Steps and Outlook
The bill will now proceed to the Bundesrat for final approval. No significant issues are expected there, as the federal states were already involved in the latest clarifications. If the “reform of the reform” passes, it will also lead to shifts in gradual implementation, with remuneration changes now scheduled to be completed by 2030. However, the concrete implementation remains crucial. Jens Baas, head of the Techniker Krankenkasse, has already cautioned that the states should not merely be “executors of local politics” that have a natural interest in preserving even outdated structures.
Source: dpa-infocom, dpa:260306-930-776125/1
