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Health Minister Lauterbach during a speech in the Bundestag

Photo: Carsten Koall / dpa

The federal government continues to approach the states in the struggle for the reform of the hospital system in Germany. In an adapted key issues paper before the consultations between Federal Health Minister Karl Lauterbach (SPD) and the heads of departments of the states, which is available to SPIEGEL, the planned allocation of medical services (service groups) to certain types of hospitals is further diluted.

For example, it is now stated that "necessary services" can also be assigned by the states to those clinics "that do not meet all the requirements of the service group". These allocations as exceptions should generally be limited in time and their results should be evaluated," it says.

Originally, Lauterbach had planned a strict division of hospitals into different levels, which were to take over certain services. Among other things, the move was intended to improve the quality of treatments. Not all hospitals should be allowed to do everything.

Hospitals are to receive more money to provide services (reserve financing) and less for a large number of complicated operations (lump sums per case). After massive resistance from some federal states, it had already become apparent that the classification of clinics at level would remain a matter for the states. This is now emphasized again in the key issues paper.

According to the paper, Lauterbach's level system is basically adhered to, the different classifications are mentioned several times. In order to prevent clinics from outsourcing parts in the future in order to meet different levels, another passage was added. Accordingly, clinics of the lowest level of care 1i can expressly "not be created by separating parts of hospitals of a higher level," it says.

Lauterbach had struck a warning tone before the consultations with the countries and urged an agreement. "We will lose clinics, but without the reform we will lose much more and unsystematically." Without the reform, 25 percent of hospitals would die, Lauterbach told the Bild newspaper. Lauterbach and his country colleagues are meeting at the moment. It remains to be seen whether they will be able to agree on common cornerstones of the reform.