(new: Updated throughout following cabinet decision and approval)

BERLIN (dpa-AFX) - Less financial pressure, more specialization for larger operations: A major reorganization is on the horizon for hospitals in Germany. On Wednesday, the Cabinet launched legislative plans by Federal Health Minister Karl Lauterbach to realign the billions in funding and establish uniform quality rules. The SPD politician said that "tens of thousands of lives could be saved" if plannable interventions were carried out in particularly suitable locations. Criticism came from the hospital sector, the federal states and the opposition, while health insurance companies warned of a cost avalanche.

Lauterbach said in Berlin that it was about a "revolution" - and also an emergency brake: without structural changes, there was a risk of clinic insolvencies, poor treatment and long distances. The reform should guarantee good inpatient care for everyone in an ageing society. It must be clearly stated that there are too many clinics. "Germany does not have the medical needs, the medical staff or the nursing staff for 1,700 hospitals." The big goal is therefore that quality counts and that the hospitals that are really needed have a sound economic basis.

The federal states responsible for hospital planning should control the change. They could say, for example, whether there are two or four locations for spinal surgery in a region, Lauterbach explained. And: "The money follows the wishes of the federal states." FDP expert Christine Aschenberg-Dugnus said that quality rather than quantity would apply in future. "That means getting away from the hamster wheel." Green Party politician Janosch Dahmen said that there was now an increase in workload that was making healthcare staff themselves ill.

Specifically, the draft, which will now be presented to the Bundestag, provides for several adjustments:

New remuneration: The system introduced 20 years ago with flat rates per treatment case is to be fundamentally changed. This is intended to free hospitals from the pressure to treat more and more cases and, in some cases, procedures for which they do not have a great deal of expertise. In future, there is to be a fixed base of 60 percent of the remuneration solely for the fact that hospitals maintain a basic level of staff and equipment for certain services, regardless of the number of cases. There will be extra surcharges for pediatrics, obstetrics, intensive care and accident medicine, special stroke wards and emergency care.

The control system: A hospital is to receive the new fixed remuneration for "service groups" assigned to it by the state. They represent medical services in more precise terms than roughly named specialist departments. The starting point is to be 65 groups, which are largely based on a model from North Rhine-Westphalia - such as "spinal surgery" or "leukemia". Uniform quality standards for specialist staff and equipment will also be defined. Lauterbach made it clear that there would be no question of cutting corners. This is to 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. "These hospitals will be protected by the reform," said Lauterbach. The federal states should also be able to designate locations as "cross-sectoral care facilities" that combine inpatient treatment with outpatient and nursing services "close to home", as the draft states. In general, the quality criteria should also be able to be met in cooperations and alliances. In order to ensure rapid accessibility, exceptions should be possible for a limited period of time, according to the ministry.

Financial injections: In view of the financial difficulties faced by 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. In order to support the transition to the new structures, a "transformation fund" is also 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 an equal amount to the financing.

Costs: The statutory health insurance funds welcomed an increase in the quality of treatment. However, the umbrella organization warned that the government's financing plans would unleash "an avalanche of costs" in an already strained financial situation. The German Social Association criticized: "It is unacceptable that those with statutory health insurance are being asked to pay alone." In the draft, the ministry points to "efficiency gains and reduced expenditure" through more coordinated, higher-quality care. Expenditure on clinics recently rose to 94 billion euros. That was a third of all service expenditure.

The timetable: The run-up to the reform began on St. Nicholas Day 2022, when a commission recommended a concept. 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.

Reactions: The German Hospital Federation protested that "flying blind" into a new financing system was an irresponsible gamble. The chair of the health ministers, Kerstin von der Decken (CDU) from Schleswig-Holstein, insisted that the unanimous demands of the federal states for more cooperation opportunities for hospitals be taken into account. The chairman of the German Patient Protection Foundation, Eugen Brysch, called for accessibility in a maximum of 30 minutes on the "Phoenix" channel. Union expert Tino Sorge (CDU) criticized a single-handed restructuring at the expense of the federal states and the insured. The Sahra Wagenknecht alliance called for "a moratorium on hospital closures." /sam/DP/men