Now comes the doctor and hospital reform! Federal Health Minister Karl Lauterbach is bringing many innovations and changes to the health system. FOCUS online summarizes what is changing for patients in hospitals and at the doctor’s.

More specialization in major operations, less financial pressure: hospitals in Germany are facing major restructuring. The cabinet launched legal plans from Federal Health Minister Karl Lauterbach that are intended to realign the billion-dollar financing and establish uniform quality rules. “Tens of thousands of lives could be saved” if planned interventions were carried out at particularly suitable locations, said the SPD politician.

So what does the new reform bring? FOCUS online summarizes the most important changes.

The biggest change affects hospitals in Germany. With his reform, Federal Health Minister Lauterbach wants to fundamentally redesign the financing, organization and range of services of the around 1,900 hospitals in Germany.

The planned reform consists of two major pillars. On the one hand, hospitals should be financed differently in the future. Instead of per treatment, the clinics will in future receive so-called retention fees. The hospitals then get most of their money for having specialist staff on hand, providing certain medical equipment or, for example, running an emergency room.

With the new reform, not all hospitals are allowed to carry out complex operations. Patients must then go to a specialist clinic for cancer surgery or a difficult heart procedure. The idea behind this is to reduce healthcare costs. If a specialist performs the operation, the chances of recovery increase and the patient can get out of the spiral of illness more quickly.

According to Lauterbach, a third of cancer treatments are now carried out in two thirds of German clinics that are completely unfamiliar with it due to a lack of experience. The result is serious complications such as sepsis (blood poisoning). That should change now.

Hospitals will be merged with the reform. To achieve this, patients have to accept longer journeys. The result is that chronically ill people, cancer patients, pain patients and heart patients may no longer be treated in the clinic in which they are treated today.

Long journeys to the clinic are not uncommon, especially in rural areas. According to the current Germany Atlas, patients now need at least 16 minutes to get to the nearest clinic. This is changing with the reform – massively.

Patients should reach the nearest emergency clinic (internal medicine, trauma surgery) within 30 minutes. Specialist clinics should be reachable in a maximum of 40 minutes by car. 

The so-called “Federal Hospital Atlas” was launched at the beginning of May. Data on around 1,700 hospitals in Germany is prepared there. Patients can check how much experience a clinic has with certain diseases and what the nursing staff is like. Whether prostate cancer or an artificial hip joint: You can see, for example, how often the respective clinic carries out a certain treatment per year – and whether that is a lot or a little compared to other hospitals.

A high number of certain treatments is no guarantee of high quality. But it can indicate that the hospital has a lot of experience with it – the more specialized a procedure is, the more important it is. To classify and compare, the number of cases provided for the respective treatment and the staffing level are shown in a kind of speedometer display .

The hospital’s emergency room will be converted into an urgent care center. An outpatient and an inpatient treatment area will be set up. There the clinic can decide whether it is a real emergency or whether the patient will be treated in the affiliated outpatient doctor’s practice. The idea: The non-emergency patient is treated on the hospital premises, but by a practice that rents space there. Disadvantage: There can be longer waiting times there than, for example, at the family doctor.

Today, emergency patients often have to wait longer in the emergency room for crucial treatment or examination. Patients with harmless symptoms are often to blame. Due to strict pre-sorting, these harmless cases of illness have to wait longer. The aim is for patients with mild colds to go to their family doctor more often.

Particularly in rural areas, it is now difficult or impossible for statutory health insurance patients to get an appointment with their family doctor if they are not already regular patients. The new reform ensures that patients can get an appointment with their family doctor more quickly.

Because the practices should get more money for treatments. The aim is to create incentives to admit more patients and at the same time treat them more specifically. From now on, practices should automatically issue prescriptions for medications that patients take regularly. The patient then simply picks them up. An appointment is no longer necessary.

According to the plans of Federal Health Minister Karl Lauterbach (SPD), everyone with statutory health insurance should receive electronic patient files at the beginning of 2025 – unless they actively reject it. Millions of patients will then have important health data such as findings and laboratory values ​​ready in an electronic file as standard.

The aim of the legislature is to bring together previously scattered treatment data, enable better treatments, and avoid multiple examinations and undesirable drug interactions. In addition, insured people should be able to easily see what data is available about them, such as allergies, implants or medications.

Patients can still see a specialist independently. However, you still have to expect longer waiting times. The law was originally intended to bring improvements here too. Patients should continue to receive an express appointment via the service number of the Association of Statutory Health Insurance Physicians 116 117 or with a specialist referral from their family doctor. For example, patients with back pain can get an appointment with an orthopedist more quickly.

Pharmacies are not affected by the new law.

There are also no changes to homeopathic services. Originally, the FDP parliamentary group and Federal Health Minister Karl Lauterbach (SPD) insisted that homeopathic remedies would no longer be covered by health insurance companies in the future. There are voices among the Greens who advocate maintaining it as a cash benefit. Baden-Württemberg’s Green Party Health Minister Manne Lucha told the “Bild” newspaper: “Many people trust homeopathy because they obviously have good experiences with it. On the other hand, the health insurance companies’ costs for these services are low.”

Lauterbach’s draft law does not provide for the removal of homeopathic remedies as a health insurance benefit, but the Bundestag can still change it during its upcoming deliberations, which is what the FDP would like. At the same time, FDP spokesman Andrew Ullmann emphasized that this was not about banning homeopathy. “Homeopathic medicines can still be purchased and taken, but no longer at the public’s expense.”

There is a lot of criticism of the planned reform from health insurance companies and the federal states. The states accuse the Federal Minister of Health of wanting to indirectly centralize hospital planning through the quality specifications.

However, hospital planning is the responsibility of the federal states. They fear that gaps in supply will arise, particularly in rural regions. Health insurance companies fear massive additional expenses and premium increases. In particular, they accuse the federal government of wanting to pass on the costs of redesigning the hospital landscape to contributors; However, health care is a public responsibility and must be shouldered by the taxpayer.

It is planned to use 25 billion euros from the health fund to support hospitals in Germany between 2026 and 2035. Converted, this means an additional annual burden on the health fund of 2.5 billion euros.

“These additional billions for the hospitals, which are to come from the health fund and directly from the health insurance companies, will consequently lead to increases in contribution rates,” said Florian Lanz, spokesman for the National Association of Statutory Health Insurance Funds, to the “Deutsche Ärzteblatt”.  

Every euro that is spent additionally must be raised by the contributors,” said Florian Lanz, spokesman for the National Association of Statutory Health Insurance Funds, to the German Medical Journal. The contributors have to pay for every additional euro that is spent.

The cost of a hospital stay can vary greatly and depends on several factors, including:

Type of hospital stay:

Kind of treatment :

Type of hospital:

Insurance status:

Example costs (Germany):

In Germany, statutory health insurance usually covers the costs of medically necessary treatment in hospital. However, additional payments of up to ten euros per day may apply for a maximum of 28 days per year. Depending on the contract, private health insurance companies often cover the costs in full, although additional services such as a single room or treatment by a senior doctor can also be covered.

For self-payers and patients without adequate insurance coverage, the costs can be significant and it is advisable to find out about the possible costs before hospitalization and to take out additional insurance if necessary.