Many hospitals in Germany are facing increasingly difficult financial situations. In order to ensure hospital care can withstand future challenges, the Federal Cabinet has now adopted a package of hospital reforms. The reforms aim to ensure high quality hospital treatments across the board and reduce hospital bureaucracy.

Federal Health Minister Karl Lauterbach said that the hospital reforms will “ensure great inpatient treatment for all members of an ageing society.” Speaking at the presentation of the draft reforms, Lauterbach said that without changes to the structure of inpatient care, there is a risk of hospital insolvencies, poor care for patients, and long journeys to hospital.

What are the hospital reforms?

The goal of the Hospital Care Improvement Act is to ensure that patients’ reasonable expectations continue to be met, the Federal Health Minister said. These included “a rural hospital, a maternity ward nearby, quick access to emergency care, and outstanding quality in complicated procedures,” he said.

The key elements of the reforms:

• A central point of the reforms is to update the system of flat-rate payments per case, which would reduce the financial pressure on hospitals to take in more and more patients. Instead, hospitals are to receive the majority of their remuneration simply for the services they provide.
• In future, hospitals are to be assigned to “service groups” based on which quality criteria they meet. These criteria are to apply uniformly across the whole of Germany. The aim of allocating hospitals to service groups is to ensure in future that services are only provided where the right equipment is available and where staff are properly trained.
• The Länder will remain responsible for hospital planning. They will decide which hospital is to provide which group of services.  
• The Länder will also be able to designate certain institutions as “Level 1i” institutions to provide services across all medical and care sectors to ensure the public can access high-quality basic care in their area. These institutions will provide inpatient, outpatient, and care services.
• Hospital documentation is to be cut to reduce time spent on bureaucracy.

Having been adopted by the Federal Cabinet, the measures will now be debated in the Bundestag. The reforms are expected to come into force in early January 2025.

A further element of the hospital reforms is the Hospital Transparency Act, which is already in force. The interactive hospital atlas will be released soon.