Germany's Bundestag has approved a series of amendments to the hospital reform that came into force just over a year ago. Lawmakers passed a compromise negotiated with the federal states on Friday, backed by the black-red governing coalition. The revised reform introduces longer deadlines for restructuring, special exceptions for smaller rural hospitals and an additional four billion euros in federal funding.
"The adjustments give the states and hospitals planning certainty with realistic deadlines for implementation," Federal Health Minister Nina Warken (CDU) told parliament. A "balanced compromise" had been reached with the states, she said, adding that support would only go to clinics "that actually adapt their structures."
On financing, the federal government will now make up to €29 billion available to the states over the next ten years to support restructuring, four billion euros more than originally planned. The original reform had also envisaged that the federal share would be covered by statutory health insurance. It will now come from the special infrastructure and climate neutrality fund instead.
The fundamental concept of the reform introduced by former Health Minister Karl Lauterbach (SPD) remains in place. At its core is a stronger medical specialisation of hospitals, with smaller clinics expected to offer fewer services and focus on procedures they perform well. The states had feared, however, that this would force too many rural hospitals to close, leaving patients facing significantly longer journeys to receive care.
SPD lawmaker Dagmar Schmidt defended the extended deadlines. "Yes, there are exceptions and transition periods," she said. "But all of them are time-limited, and there are clear conditions." She stressed that the commitment to quality in healthcare provision would be maintained. The Greens accused the federal government of watering down the original reform and prolonging inefficient and costly structures. Lawmaker Janosch Dahmen accused the government of a "de facto reversal of the hospital reform."
The Left party criticised the plans as likely to lead to the closure of necessary hospitals due to insufficient funding. "The case-based flat rates are structured in such a way that many areas of basic care are systematically underfunded," said lawmaker Ates Gürpinar. The AfD accused the government of creating a "bureaucratic monster." "The ones who suffer from this botched hospital reform remain the rural regions of Germany," said lawmaker Martin Sichert. "The dying of hospitals continues unabated."
Medical representatives welcomed the return of clarity after months of uncertainty. The Marburger Bund criticised the new remuneration rules for creating "additional bureaucracy without giving clinics more financial security." The Hartmannbund said the compromise "relies too heavily on transitional and exceptional arrangements, pushing key structural decisions back once again."
The Patient Protection Foundation called the decision a "disappointment," saying billions were being spent "on a watered-down structural reform without fundamentally improving inpatient care for sick people," according to foundation director Eugen Brysch. AOK Federal Association chair Carola Reimann described it as an "acceptable compromise" but warned it would slow the reform process given "long implementation deadlines and exceptions to quality requirements for clinics."
She predicted this would not be the last reform law in the hospital sector. The compromise must still be confirmed by the Bundesrat, which is expected to address the matter at its next session on 27 March. Hesse's Health Minister Diana Stolz (CDU) said the compromise did not meet state expectations "in all respects" but called it "a decisive step towards the urgently needed legal certainty for the further reform process."
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