The German parliament has approved a law to restructure the healthcare system, reducing the number of hospitals, expanding clinics, and streamlining bureaucracy through digitalization. Health Minister Karl Lauterbach described the reform as a “revolution.”
Germany’s upper house of parliament has approved a law to restructure the hospital sector, setting the stage for gradual implementation from January 2025 to 2029. The reform, championed by Health Minister Karl Lauterbach, aims to overhaul hospital financing and improve care standards. Lauterbach described the changes as a “revolution” in German healthcare, comparing them to a historic turning point (Zeitenwende), similar to Chancellor Olaf Scholz’s military overhaul after Russia’s invasion of Ukraine.
The two-pronged reform will change hospital funding models and introduce new care standards. Germany has the highest number of hospital beds per capita in the EU (7.9 per 1,000 people vs. an EU average of 5.3), which is financially unsustainable. To address this, hospitals will no longer be paid per treatment but will receive a guaranteed income for maintaining essential services. This shift is intended to reduce unnecessary hospital stays, improve patient referrals to specialists, and lower overall health costs. Lauterbach claims the reform could save tens of thousands of lives per year by ensuring that hospitals only perform procedures they are properly equipped for.
The downsizing of hospitals is a major aspect of the reform, with several hundred hospitals expected to close due to insufficient demand. Currently, one-third of all hospital beds remain empty, yet there is a shortage of nurses. Lauterbach argues that centralization will enhance care quality, ensuring that patients receive specialized treatment at better-equipped facilities.
“The hospital reform is right and important,” Dirk Heinrich, an ear-nose-throat specialist and chairman of the doctors’ association Virchowbund.
“We do have too much in-patient care, but what is happening now is way too little. Reforming the hospitals without a comprehensive outpatient treatment reform, and without emergency care reform, won’t make a difference.”
Eugen Brysch, chairman of patients’ protection organization Deutsche Stiftung Patientenschutz was also skeptical:
“In the field of outpatient medical care, elderly, chronically ill and care-dependent people will find it almost impossible to find a new doctor, … The fact that better earning opportunities are now being created will not in itself lead to more doctors in rural areas. After all, other location factors also play a role”.
Germany also struggles with a lack of doctors’ offices in rural areas, as fewer doctors want to live there. The Health Ministry wants to tackle this issue by offering extra money for clinics in rural areas.
The reform also removes payment caps for general practitioners, an issue that had led to doctors occasionally treating patients for free. However, specialist doctors remain subject to budget constraints, meaning that while patients may get faster appointments with family doctors, they may still face long waits for specialist care.
Critics, including medical associations and patient advocacy groups, warn that the reforms do not address broader issues such as outpatient care and emergency services. Additionally, rural areas face a shortage of doctors, and while financial incentives are being introduced to attract doctors to these regions, experts argue that other factors, such as quality of life and infrastructure, also play a crucial role in attracting medical professionals.
The reform will also contribute to higher health insurance contributions in 2025, although Lauterbach insists that no additional increases will be necessary if the full reform package is implemented successfully.
In summary, while Germany’s hospital reform law seeks to improve efficiency, cut costs, and enhance care quality, concerns remain about accessibility in rural areas and long wait times for specialists. The government hopes that a more centralized, service-oriented system will ultimately lead to better patient outcomes and long-term cost reductions.
