A significant overhaul of Germany’s ambitious hospital reform plan is reportedly nearing approval, signaling a retreat from the initial, sweeping changes and raising questions about the government’s commitment to its stated goals. A draft proposal, revealed by POLITICO and reportedly headed for cabinet approval on Wednesday, suggests a pragmatic, albeit potentially diluted, approach to modernizing the country’s healthcare infrastructure.
The adjustments, detailed in a letter from Health Minister Nina Warken (CDU) to the Chancellery, appear designed to ease the practical implementation of the reform, but critics argue they represent a capitulation to lobbying pressure and a lack of resolve in addressing systemic challenges. The agreement, reached within the governing coalition, directly alters previously agreed-upon stipulations outlined in the coalition treaty.
Key modifications include postponing the introduction of a new “performance remuneration” system by a year, pushing full implementation to 2030. This delay draws immediate scrutiny regarding the reform’s efficacy in delivering intended financial incentives for hospitals. Furthermore, the elimination of accessibility requirements for exemptions and collaborative arrangements cedes significant power to individual states, allowing them to determine how to secure comprehensive care in consultation with health insurance providers. This decentralization risks uneven implementation across the country, potentially exacerbating existing disparities in healthcare access.
The financing structure of the Hospital Transformation Fund (KHTF) is undergoing a considerable shift. Originally slated to be funded entirely by statutory health insurance contributions – a considerable 25 billion euro burden – the funding now pivots to utilize resources from the “Infrastructure and Climate Neutrality” special fund. While the federal government pledges substantial contributions between 2026 and 2035, this reallocation raises concerns about the long-term stability of the fund and the potential diversion of resources from other critical climate and infrastructure projects.
The government’s promise to explore “incentive systems” for the parliamentary process hints at a recognition that the initial proposals lacked broad support and will require further concessions. The fact that the draft legislation reportedly bypasses the Bundesrat (Federal Council) indicates a desire for swift passage, potentially limiting opportunities for critical debate and scrutiny from the opposition and regional stakeholders.
The changes reflect a complex interplay of political maneuvering, budgetary constraints and concerns about the practical feasibility of the original hospital reform. While framed as necessary adjustments to ensure successful implementation, the modifications raise fundamental questions about the coalition’s commitment to a transformative overhaul of the German healthcare system and whether the changes will ultimately deliver the promised improvements in patient care and hospital stability.