(de-news.net) – The hospital reform has passed the Bundestag. Federal Health Minister Lauterbach (SPD) has explained that he expects closures, especially in clinics in western Germany. He said: “It is quite clear that in ten years at the latest we will have a few hundred fewer hospitals. And that is correct. We do not have the medical need for these hospitals.” In the hospitals concerned, every third bed is empty and staffing levels are thin. As in other countries, care for complicated procedures must be more centralized, Lauterbach pointed out, adding that many clinics are in debt and are facing insolvency.

The hospital reform was passed on Thursday. The health system with a view on clinics, which has so far been based on flat-rate fees, is to be restructured. In future, flat-rate provisioning fees will ensure that 60 percent of operating costs are covered. In addition, so-called service groups will guarantee nationwide quality criteria. This means that interventions will only be possible in hospitals with sufficient staff and adequate equipment. Finally, the know-how for corresponding interventions with pre-, co- and post-treatment should be available in the hospitals.

“We have under-supply, oversupply and incorrect treatment side by side,” explained Lauterbach in the Bundestag. Under-supply exists, for example, in pediatric medicine and in the case of strokes. This costs human lives, the minister criticized. In the case of cancer treatment, incorrect treatment occurs where clinics are not specialized, and oversupply occurs in the case of knee prostheses. The flat-rate provisioning fees, which are intended to relieve hospitals of financial pressure, will ensure “that the coexistence of oversupply, incorrect treatment and under-supply be eliminated.” Hospitals with high-quality services will thus be protected.

Service groups will describe hospital treatments more precisely. In smaller rural hospitals, specialists will be based in the future to provide outpatient treatment. In general, small hospitals will offer fewer services with less complex services. In contrast, it is planned that clinics with departments for internal medicine and general surgery will be accessible within 30 minutes by car.

The CDU criticized the need for bridging financing for the transition. It has already been announced that the opposition wants to call on the mediation committee between the Bundestag and Bundesrat in order to block the law and bring about changes – although the law does not require approval by the federal council. Schleswig-Holstein has taken the lead in this.

Before the vote in parliament, the chairman of the German Hospital Association, Gaß, warned of negative consequences. There is a risk that clinics outside of the big cities will die out. The reform is equivalent to a cold market consolidation. An impact assessment, for example with regard to basic patient care in rural areas, is not yet possible.

It is planned that a transformation fund with a volume of 50 billion Euros will be used to finance the reform over a period of ten years, half of which will be paid for by the Federal Government and the other half by the Länder. The Federal Government wants the health insurance funds to be used for its share, but the health insurance companies could take legal action against this. What is more, the Federal Audit Office has stated that health care is the responsibility of the state and not a matter for taxpayers and contributors.

Aside from the hospital reform, a law will make it possible to compare the qualitative performance in health insurance. Lauterbach added that he could imagine a reduction of “a few dozen” health insurance companies.

Thorsten Koch