BERLIN (dpa-AFX) - CSU state group leader Alexander Dobrindt is calling for a stronger approach to the federal states on the planned hospital reform. Health Minister Karl Lauterbach (SPD) must sit down at the table with the states on this central issue and not make policy against the states, Dobrindt told the German Press Agency. "This kind of confrontational approach by the federal government is damaging medical care in Germany. This is not acceptable." Dobrindt criticized: "This hospital reform is completely unbalanced." It disregards the federal states, leads to higher costs for contributors and will lead to a deterioration in rural areas.

The federal cabinet launched the legislative plans on Wednesday. They are intended to reduce financial pressure on hospitals and establish uniform quality rules. To this end, the current remuneration system with flat rates for treatment cases is to be changed. In future, clinics are to receive 60 percent of their remuneration for providing certain services. The basis for financing by the health insurance funds is also to be more precisely defined "service groups". They are to describe hospital treatments more precisely and define minimum requirements.

The federal states are unanimously calling for changes to the plans. However, Lauterbach has no longer drafted the law in such a way that it requires approval in the Bundesrat. The draft will now be discussed in the Bundestag. The law is due to come into force at the beginning of 2025, with implementation to follow in the years thereafter.

Nevertheless, Bavaria wants to push through changes via the state chamber. "Bavaria will now insist in the Bundesrat that corrections are made to the reform after all," Bavarian Health Minister Judith Gerlach (CSU) told the Augsburger Allgemeine newspaper (Thursday). "I could also well imagine a mediation committee if Lauterbach does not respond sufficiently to the demands of the federal states," said Gerlach, referring to an initiative from Baden-Württemberg. The federal states could use this to slow down the process. Legal action as a last resort is not off the table either, said Gerlach. A key demand is that the federal government quickly supports hospitals financially until the reform takes effect.

The CDU/CSU also fears higher health insurance contributions as a result of the reform. CSU health expert Stephan Pilsinger assumes an additional burden of up to 0.5 percentage points for contributors, as he told the Redaktionsnetzwerk Deutschland (RND/Donnerstag). 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 between 2026 and 2035 ? provided that the federal states each contribute the same amount to the financing.

Lauterbach made it clear that negotiations were still ongoing with the federal states. The minister justified his approach on Wednesday evening in the "Spiegel" "top-level discussion" by saying that he did not want to water down the reform in advance. The reform is very much based on what his house considers to be right. It was important that there should be no cutbacks in the quality of care. However, this is what the proposals from the federal states amount to. "We don't agree with that," said Lauterbach. However, negotiations are still ongoing.

When presenting the plans, Lauterbach spoke of a "revolution", but also of an emergency brake. Without structural changes, the minister emphasized the threat of clinic insolvencies, poor treatment and long distances. At the same time, the SPD politician made it clear that there were too many clinics. Germany did not have the medical needs, the medical staff or the nursing staff for 1700 hospitals.

The German Social Association criticized the fact that the planned transformation fund was to be financed solely by statutory health insurance and not by private health insurance. Nevertheless, the reform is a step in the right direction, said Michaela Engelmeier, chairwoman of the association's board, to the Augsburger Allgemeine newspaper. In the further process, the FDP wants to ensure that the reform is implemented with as little bureaucracy as possible, as parliamentary group leader Christian Dürr told the RND.

Kerstin von der Decken (CDU) from Schleswig-Holstein, Chair of the Conference of Health Ministers, made it clear that the federal states had supported the aims of the reform from the outset. However, she said on the ARD program "Tagesthemen" that they did not agree with the result that had now been presented. She warned that if the law is passed as it stands, it will partly improve the reform, but partly worsen it. The latter would apply above all to rural areas, where small clinics could face closure. The law was made for large providers and conurbations, but not for rural regions, the CDU politician complained./sam/DP/zb