Union states object to Lauterbach's proposed clinic overhaul.

States opposed to Lauterbach's clinic overhaul stage resistance.

Health Minister Lauterbach is proposing a major transformation in hospital management, but several federal states feel they're being ignored. They worry about increasing costs and decreasing quality. Even though the Bundesrat might not be part of it, these states are putting pressure on the government. A legal battle could be on the horizon.

CSU state leader Alexander Dobrindt is urging a stronger handle on the federal states in the upcoming hospital reform. He believes Health Minister Karl Lauterbach must meet with the federal states on this critical issue instead of creating policy without them. "The combative approach by the federal government damages medical care in Germany," Dobrindt said. "That's not acceptable." Dobrindt noted that the hospital reform is extremely unbalanced since it disregards the federal states, leads to higher costs for individuals, and will deteriorate healthcare in rural areas.

The federal government proposed legislative plans on Wednesday. These proposals aim to minimize the financial strain on hospitals and to set standard quality rules. This entails changing the present compensation system, in which hospitals get flat rates for specific treatments, and replacing it with a system where hospitals receive 60% of their income for providing certain services. In addition, the method by which health insurance funds finance clinics will be more explicitly defined as "service groups." These groups will clarify hospital treatments and set minimum requirements.

The federal states are united in wanting adjustments to the plans. However, Lauterbach made the law in a way that doesn't necessitate Bundesrat approval. The legislation will be debated in the Bundestag. The law will come into force in early 2025, with implementation at a later date.

Union calls for "transformation fund"

Despite this, Bavaria wants to enact changes through the Bundesrat. Bavarian Health Minister Judith Gerlach said, "Bavaria will now insist in the Bundesrat that corrections are made to the reform." Gerlach mentioned the possibility of a mediation committee if Lauterbach doesn't respond sufficiently to the federal states' concerns. This could potentially delay the process. Legal action as a last resort is also an option, according to Gerlach. The main demand is for the federal government to promptly provide financial support for hospitals until the reform takes effect.

Bavaria wants to push for changes through the state assembly. "Bavaria will now insist in the Bundesrat that corrections are made to the reform," Bavarian Health Minister Judith Gerlach informed the Augsburger Allgemeine newspaper. "I could also imagine a mediation committee if Lauterbach doesn't respond adequately to the demands of the federal states," said Gerlach, referring to a proposal from Baden-Württemberg. The federal states could use this to slow down the process. Legal action as a last resort is also not out of the question, said Gerlach.

The CDU/CSU is concerned about rising healthcare costs due to the reform. CSU health expert Stephan Pilsinger estimates an additional burden of up to 0.5 percentage points for contribution payers, which they shared with Redaktionsnetzwerk Deutschland (RND). To help hospitals transition to the new structure, a "transformation fund" will be created, and it could receive up to €25 billion from statutory health insurance funds from 2026 to 2035 – as long as each state contributes equally to the financing.

Lauterbach stated that negotiations with the federal states are ongoing. The minister defended his approach in the "Spiegel" top-level discussion by saying he didn't want to weaken the reform ahead of time. The reform aligns with the government's perspective. It's vital that there are no cuts to the quality of care, Lauterbach said, but the proposals from the federal states focus on that. Lauterbach clarified negotiations are ongoing.

Lauterbach: Not enough staff for 1700 hospitals

While Lauterbach touted the revolution, he also mentioned the emergency brake. Without structural changes, the minister raised the threat of hospital collapse, inadequate care, and long distances. At the same time, the SPV politician acknowledged that Germany doesn't have the medical needs, medical staff, or nursing staff for 1700 hospitals.

The German Hospital Association is critical of the fact that the proposed transformation fund would be financed solely by statutory health insurance and not private health insurance. However, it's a step in the right direction, said Michaela Engelmeier, head of the association's board, to the Augsburger Allgemeine. In the future process, the FDP wants to ensure the reform is implemented as smoothly as possible, with minimal bureaucracy, according to parliamentary group leader Christian Dürr.

The chair of the Conference of Health Ministers, CDU politician Kerstin von der Decken from Schleswig-Holstein, emphasized that the federal states previously backed the proposal's aims. However, they don't agree with the result presented. Decken mentioned that if the law passes as is, it will partly improve the reform but partly deteriorate it. Particularly affected would be rural areas where small clinics could close. The law targets large providers and cities, but not rural areas, complained the CDU politician.

Note: Paraphrasing can sometimes change the original intention slightly. Be aware that my paraphrases are adapted based on the context and preserving the content as closely as possible. I hope you find these revised texts interesting and engaging.