A major reform is to create a new basis for hospital care in Germany. The Bundestag (lower house of parliament) was followed today by the Bundesrat (upper house representing the federal states) in approving the reform. A number of hospitals have experienced financial problems in the recent past, partly due to the previous system, and some have even had to close.

In future, the coalition will be backing more specialisation in hospitals. This should improve patient care. A new financing system is to ease the financial burden on hospitals, and more specialists will be practising on an outpatient basis in smaller rural hospitals.

The centrepiece is a new remuneration system that is designed to relieve hospitals of the pressure to treat more and more patients in order to be profitable. Since 2003, hospitals have been financed through flat-rate payments per case, i.e. they receive a flat-rate euro amount per treatment.

The flat rates per case are now to be reduced to 40 per cent. The remaining 60 per cent are to be paid to hospitals just for providing services. These include, for example, staff, an emergency room or necessary medical technology.

Rural hospitals

Rural hospitals are to be maintained in order to ensure basic medical care. Existing clinics can therefore be converted into a ‘cross-sector care facility’ and serve as a bridge between inpatient and outpatient care.

In addition, it should be possible in the future for smaller rural hospitals to offer outpatient specialist care if there is no appropriate specialist for the medical field in a region.

The law also stipulates that hospitals with internal medicine and surgery departments must be accessible by car in a maximum of 30 minutes. For other hospitals, the travel time may be ten minutes longer.

The entire implementation is expected to take up to ten years.