That a major hospital reform is necessary – the federal and state governments agree on this. On the other hand, there is disagreement about the «how». Federal Health Minister Karl Lauterbach is getting more and more headwind from the federal states. 3 federal states now even want to have the reform legally examined.
At the end of February, Lauterbach confident: «We are well on the way to a common result,» said Lauterbach after the meeting of the federal-state working group.The February meeting was the 2nd of a total of 6 agreed consultation dates. The consultations are based on theRecommendationsof the «Government Commission for Modern and Needs-Based Hospital Care», which was established in May 2022. A key issues paper is to be ready by the summer.
It is planned to free the clinics from economic pressure by, among other things, reducing the case flat rates. This should reduce incentives to treat as many patients as possible. In return, the clinics should receive fixed amounts for the provision of staff, an emergency room or necessary medical technology. The plans aim to classify the grown hospital network into 3 levels of care and to finance them accordingly — from basic care close to home to a 2nd level with further offers to maximum care providers such as university hospitals.
Legal opinion on the constitutionality of the reform plans
A concrete draft law is not yet available, but North Rhine-Westphalia, Bavaria and Schleswig-Holstein now want aLegal opinions on the constitutionality of the reform plans on hospital remuneration commissioned To give.Prof. Ferdinand Wollenschläger, Professor of Public Law, European Law and Public Commercial Law at the University of Augsburg, is to produce results this spring, the health ministers of the 3 countries announced. «We do not want to approach the planning law of the federal states,» Lauterbach clarified andwelcomese the planned report.
The three states also had a great interest in the reform succeeding, said North Rhine-Westphalia’s Minister of Health Karl-Josef Laumann (CDU). It is crucial that the countries retain their competences of hospital planning . One could not agree to a reform that deprived countries of legroom to shape. «The report is intended to clarify where the federal government has limits in the implementation of its hospital financing reform,» said Laumann.In the hospital sector, the Länder should not become the pure implementing authority of the Federal Minister of Health.
There have been tensions between Laumann and Lauterbach for some time. According to Laumann, the 337 hospitals in North Rhine-Westphalia will have to concentrate on certain services in the future and will no longer offer everything. At the beginning of March, however, Lauterbach had warned his NRW colleague to continue the already initiated hospital reform for the most populous federal state on his own.
Clearly too many hospitals in Germany
As Bavaria’s Minister of Health Klaus Holetschek said, it should be clarified whether the federal government wants to govern in the hospital planning of the states. «Hospital planning is a matter for the federal states,» says Holetschek. Of course, there is a link between the planning of the clinics and the remuneration. «We want to know where the red line is, from which the federal government violates the constitutional competences of the states,» said Holetschek.
Schleswig-Holstein’s Minister of Health and Justice Kerstin von der Decken (CDU) emphasized the need for a hospital reform, said but also: «The structural changes planned by the federal government intervene massively in the hospital planning of the states and have considerable cost consequences.»
In Germany, there are «clearly too many hospitals,» said KBV boss Dr. Andreas Gassen.»As part of the hospital reform, we will of course have to dismantle or convert hospitals. Anyone who says otherwise closes his eyes to reality,» says Gassen opposite of the Neue Osnabrücker Zeitung. Historically, there are too many hospitals in Germany, according to Gassen. «It would therefore be only logical for us to concentrate the staff we have at the clinics that we undoubtedly need.
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Source — https://www.univadis.de/viewarticle/s/lauterbachsche-krankenhausreform-nicht-2023a10005hi