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Federal Minister of Health Karl Lauterbach

Photo: Clemens Bilan / EPA

In the dispute over the reform of hospital financing, Federal Health Minister Karl Lauterbach has stepped up. Before the upcoming further consultations on his plans, he warned against hesitation. "We are at the beginning of an uncontrolled hospital death," said the SPD politician of the "Bild" newspaper. Without the reform, 25 percent of hospitals would probably die."

In doing so, Lauterbach is responding above all to the criticism of several federal states that are resisting the planned interventions. Above all, they defend their own decision-making authority over which hospitals will remain in place under the new rules in the future. In recent decades, the dismantling of clinics that operate unprofitably and with low standards has mostly failed in favor of better-positioned hospitals due to resistance from local politicians.

Bavarian Health Minister Klaus Holetschek (CSU) once again called on Lauterbach to revise his reform plans. "Anything else is unconstitutional." The countries must be able to decide for themselves what care takes place where, he told the "Redaktionsnetzwerk Deutschland". It should not come to the point that decisions are made at the "green table in the Berlin bubble" about the local hospitals. I see the current proposals for reform as endangering local care, especially in states such as Bavaria," he warned.

Clinics in financial distress

In fact, the hospital system is faltering. 60 percent of hospitals were in the red last year. With his reform, Lauterbach wants to combat the financial difficulties of hospitals and at the same time ensure better care. In essence, the remuneration system, in which lump sums have been paid for treatment cases, is to be changed. As a result, the clinics were anxious to give preference to the most lucrative treatments possible. Now, the houses are to be freed from economic pressure by receiving money for the provision of services. In addition, they should also be able to offer more outpatient services. Uniform quality criteria are also planned so that hospitals can provide certain services.

For this reform, the clinics are to be divided into levels according to Lauterbach's ideas, depending on their care performance. This point is particularly explosive for the countries. They criticize that smaller houses in the countryside would have fewer chances in the future. For this reason, the discussions are currently circling mainly and these planned classifications of the hospital network - from basic care close to home to a second stage with further offers to maximum care providers such as university hospitals.

Smaller houses for basic services

In fact, smaller houses should not be eliminated. With "Level Ii" clinics, as they are called in the plans, a new possibility of on-site care is to be created. The mostly small hospitals that fall under this should have a basic inpatient offer, but also offer outpatient specialist services. Operations that require specialists and greater experience are more likely to be offered in larger and more specialized clinics.

In the struggle for the reform, Lauterbach will meet this Thursday in Berlin for further consultations with his country colleagues. The Federal Minister had made it clear that he was aiming for more concrete proposals for a law over the summer.