Based on the third statement and proposals from the
Government Commission for a Modern and Need-Based Hospital Sector [1],
the Federal Minister of Health and the Ministers of Health in the 16
Federal States started discussions on a fundamental reform of hospital
remuneration in January 2023.
In its coalition agreement from
2021, the Federal Government agreed on reforms in the hospital sector,
especially to expand the Diagnosis Related Groups (DRG)-based
remuneration through the introduction of flat fees and to develop a new
instrument for hospital planning based on defined service groups and
hospital levels. For this, the Federal Minister of Health appointed an
independent Government Commission to develop recommendations. The
Commission published its proposal in December 2022, which combines the
remuneration via flat fees with the new instruments of defined service
groups and hospital levels (see Policy Analysis from December 2022).
Since
2004, hospital remuneration in Germany has been – apart from capital
costs – based entirely on caseloads via DRGs. The Government Commission
argues in its report that the current system leads to an increase in
inpatient cases. Further, an international comparison shows that
inpatient numbers are generally higher in Germany, especially for
planned procedures like hip and knee replacements and avoidable hospital
admissions like asthma or congestive heart failure [1]. A large number
of hospitals, including many small ones without basic emergency
facilities like stroke units, further characterize Germany’s health
system.
Hospital remuneration is subject to federal law, but
the states are in charge of hospital planning. Therefore, the Federal
Minister of Health needs a common ground with colleagues from the states
to realize the main aspects of the planned reform. So far, many
stakeholders in politics and the health sector have shown agreement with
the principle recommendations [2–5]. One potential challenge will be to
define homogeneous service groups and hospital levels between the
states.