Hospital reform: The goal is clear – but who is driving the change?

What dynamic times have we experienced in health policy over the past two years: North Rhine-Westphalia has implemented a radical reform of state hospital planning. The Federal Government's expert commission has put forward proposals for the further development of healthcare structures and initiated a critical discussion on the goals and paths of transformation.

Adjustments were agreed upon, compromises agreed upon, and implementation plans drawn up. At the end of the traffic light coalition, the then-not-so-major hospital reform barely made it across the finish line. And now? Will we see the same dynamic in the change processes with the new federal government and a new leadership in the Ministry of Health? I fear not – unfortunately! Rather, timelines could be gradually relaxed and requirements and regulations watered down.

While all stakeholders never tire of lamenting the increasing pressure for change in the German healthcare system for years, there is the demographic shift that has been evident for decades, which is having a noticeable impact on healthcare in two ways: On the one hand, the people who need medical care are getting older and thus more multimorbid. At the same time, the number of people available for professional care is declining dramatically.

Status quo is not a promising perspective

The concentration of care on what is essential is becoming inevitable, especially since financial resources remain limited. Innovations in medicine can further strain these limited resources, but they can also provide solutions to the scarcity problem: Consistent outpatient care with the expansion of telemedicine and the consistent use of digital innovations – especially AI – can reduce the effort and costs of care while simultaneously improving quality. But all of this means change – and with it resistance. Maintaining the status quo is not a promising prospect, neither for patients nor for service providers.

Over the past decades, there have been many attempts to develop the framework conditions in a contemporary and needs-based manner through reforms and reforms of reforms. Given the frequent failure and disruption of these reforms in the legislative process between the federal government, the states, and local governments, some might feel something like resignation and simply call for more money to refinance structures that no longer meet needs and are no longer staffed. I'll admit it openly: Just a year ago, I was very optimistic that it would be possible to initiate radical changes in the healthcare structures. In fact, I even described the opportunity as historic. Delays or pragmatic implementation?

The confluence of many factors has made me so optimistic: the universally accepted pressure to act, the mature societal willingness to accept or at least tolerate changes in the healthcare landscape that were considered unreasonable until just a few years ago; and, last but not least, some courageous political players – especially Federal Minister Lauterbach – who consistently pursue the goals of a needs- and quality-oriented, concentrated service structure. It now remains to be seen whether the change at the top of the Federal Ministry will lead to further delays or a swift and pragmatic implementation.

Even if we can't directly influence the latter, I am convinced that hospital management can and must actively and constructively contribute to the ongoing change process: We should take action, make suggestions, and demonstrate with concrete implementation how care can be improved and more needs-based. This includes consolidating services and provisions, establishing and energizing networks, and thus reducing overprovision.

This is precisely what we want to discuss together at the Health Management Congress as part of the Capital City Congress. Through bold and creative action in transforming the healthcare landscape, we can urge the new political decision-makers to consistently pursue the path they have chosen for hospital reform. Let us accelerate the pace of implementation through concrete and pragmatic proposals for necessary adjustments to the reform package, instead of jeopardizing what has been achieved through hesitation and procrastination.