The proposals for a hospital reform presented by Federal Health Minister Karl Lauterbach (SPD) are met with skepticism in some federal states.

North Rhine-Westphalia's Health Minister Karl-Josef Laumann warned on Deutschlandfunk on Wednesday that hospital planning should not be controlled centrally from Berlin.

The clinic landscape in Mecklenburg-Western Pomerania cannot be compared to that in North Rhine-Westphalia, and that in the Rhineland cannot be compared to that in Westphalia, argued the CDU politician.

"Hospital planning is a state matter and must remain a state matter."

Britta Beeger

Editor in business and responsible for "The Lounge".

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Bavaria's Health Minister Klaus Holetschek (CSU) was even more drastic.

The recommendations of the government commission, which, according to Lauterbach, should form the basis for a hospital reform, interfered "unreasonably with the hospital planning competence of the federal states," he said.

They amounted to “a centrally controlled, quasi-planned and highly theoretical system”.

Case flat rates lead to false incentives

The commission, made up of physicians, economists and lawyers, had proposed dividing clinics into three categories: basic providers, standard and priority providers and maximum providers such as university hospitals.

In order to increase quality, 128 performance groups are to be defined, such as "cardiology".

Treatments should only be able to be billed if a clinic is part of the respective service group.

In principle, however, there is a lot of agreement with the reform proposals.

This applies in particular to the recommendations for a new compensation structure.

As a result, inpatient care should be based more on medical and less on economic criteria.

According to a widely held view, the previous case flat rates that hospitals received per patient and diagnosis lead to false incentives: there are too many unnecessary operations, while at the same time pediatric wards are closing because they do not make economic sense.

In the future, hospitals are to receive fixed amounts for providing staff, medical equipment and an emergency room.

The case flat rates then play a smaller role.

It was "right and important" that the flat rate system be changed, said Holetschek.

However, there is criticism that the clinics should not receive more money on balance.

The German Hospital Society complained that the reform was based on structural underfunding.

For years, the federal states have not met their obligation to adequately finance hospital investments - here alone there is a lack of 4 billion euros annually.

This is one of the main reasons for the tense economic situation in many hospitals and the shortage of staff.

The Government Commission also writes in its statement that there is a "creeping and, over time, serious loss of substance".

According to its own statement, it intends to present proposals for new financing of the investments in a timely manner.