BERLIN (dpa-AFX) - After months of preparatory work, the planned major reform of Germany's hospitals is set to get underway. Health Minister Karl Lauterbach (SPD) will present legislative plans to the cabinet on Wednesday (11.00 a.m.), which are intended to realign the billions in funding. The goals: less economic pressure, more specialization and uniform quality rules. There is ongoing criticism of the plan from the federal states and the hospital sector, while the statutory health insurance funds are warning of a watering down of important aspects.

Lauterbach has already made it clear that this is nothing less than "a kind of revolution" for the network of 1700 clinics ? and that they are doomed to success. "If the ball bounces off our feet, not only would we no longer be able to avert a disorderly death of hospitals in the next few years, but we would also have to contend with quality deficits that would be very difficult for the public to understand," he argued recently after a meeting with the federal states.

The problem: up to now, there has been "an economic incentive to treat as many patients as possible", according to the draft. This could lead to certain treatments being carried out not only for medical reasons, but also in part to increase revenue. There is a risk that clinics will no longer offer supposedly less lucrative services or cease operations regardless of the regional demand for care. As many hospitals only provide certain services infrequently and therefore have little experience, this results in quality deficits that "can have a negative impact on the well-being of patients".

New remuneration: Around 20 years ago, flat rates per case were introduced to make the system more efficient. Lauterbach was also involved as a consultant at the time. Since then, clinics have received a lump sum per treatment case. In future, there is to be a fixed base rate of 60 percent of the payment solely for the fact that clinics maintain a basic level of staff and equipment for certain services - regardless of the number of cases. Extra payments are to be made for pediatrics, obstetrics, intensive care and emergency care, among others.

The control system: A clinic is to receive the new retention payment for "service groups" that are assigned to it by the state. They represent medical services, more precisely defined than roughly named specialist departments. The starting point is to be 65 groups, which are largely based on a model from North Rhine-Westphalia. They are called "spinal surgery" or "leukemia", for example. Uniform quality standards for specialist staff and equipment are also defined in each case. This should ensure that cancer treatments, for example, are carried out in clinics with specialist knowledge.

Small clinics: The retention fee is also intended to secure the existence of smaller hospitals, particularly in rural regions. The federal states responsible for planning should also be able to designate locations for "cross-sector care facilities". These should "combine inpatient hospital treatment with outpatient and nursing services close to home", as the draft states.

Financial injections: In view of the financial difficulties of many clinics, the wage costs for all employees are to be fully financed by the statutory health insurance funds from this year onwards, rather than just half. There are already concerns in the health insurance companies' camp with regard to upcoming wage negotiations. In order to support the transition to the new structures, a "transformation fund" is to be set up, from which up to 25 billion euros could flow from the statutory health insurance funds from 2026 to 2035 ? provided that the federal states each contribute the same amount to the financing.

Costs: The health insurance funds will incur additional costs ? a mid three-digit million euro amount alone for the full assumption of wage costs in 2024. "In addition, there will be additional annual costs from 2025 that cannot yet be quantified," the draft states. This would be offset by efficiency gains and reduced expenditure from 2025 due to more coordinated, higher-quality care. Expenditure on hospital treatment recently rose to 94 billion euros - around a third of all healthcare expenditure. In order to relieve the burden on clinics, the individual checking of all invoices that they send to the health insurance funds is to be replaced by random checks.

Timetable: The long run-up to the reform began on St. Nicholas Day 2022, when a government commission recommended a concept for it. Lauterbach is aiming for the first reading in the Bundestag before the summer break. The law should then come into force on January 1, 2025, but it remains to be seen how smoothly the process will run. The traffic light coalition is standing together on the issue, but disputes with the federal states continue to simmer. Lauterbach has no longer designed the law in such a way that it requires approval in the Bundesrat. The new structure is to be implemented step by step at a later date. For example, the new retention fee is to become "budget-effective" from 2027./sam/DP/zb