KHAG leaves fundamental problem unresolved
11.08.2025 14:08
The draft Hospital Reform Adjustment Act (KHAG) falls short of the expectations of many hospitals. Bernadette Rümmelin, Managing Director of the Catholic Hospital Association of Germany, commented:
"Although the federal government now grants the states some leeway, for example, in the allocation of service groups or the definition of locations that meet needs, this is only for a limited period. Therefore, the draft means one thing above all for local hospitals: continued waiting, continued uncertainty, especially regarding appropriate service funding."
Postponement is not a solution
Despite important adjustments, the new government is sticking with the controversial reserve compensation. Instead of fundamentally revising the system and adapting it to actual costs, the federal government is content with merely postponing it.
"The fundamental problem remains unsolved: In its current form, reserve funding is a purely technical distribution instrument with no discernible added value. However, future-proof hospital care requires more than a highly complex and, moreover, completely non-transparent calculation model. Thus, the planned reserve funding in its current form falls short of real requirements," says Rümmelin.
"We need a provision for hospitals that is based on the actual provision costs that hospitals incur to ensure comprehensive care. This applies especially in regions with low caseloads but high care responsibility. Staff, infrastructure, and 24/7 availability generate high fixed costs. The provision for hospitals falls short of this cost profile and thus places further pressure on smaller, but essential, locations. Therefore, it must be clarified in the further process that the provision for hospitals will be suspended and fundamentally revised," Rümmelin continued.
Countries are now obliged
On the positive side, however, the removal of accessibility requirements as a prerequisite for exceptions to the allocation of service groups is a positive development. Particularly in rural regions with already limited hospital capacities, the strict application of accessibility criteria could have led to certain services, such as obstetrics or general internal medicine, no longer being provided, even though there is no local alternative for the population. Now, the states can decide for themselves which hospitals continue to play an important role in providing public services. In the future, the states will also be able to assign service groups if hospitals, without which the provision of care would be jeopardized, do not currently meet the relevant quality criteria.
Bernadette Rümmelin concluded: "Exceptions are important because they provide the states with the necessary flexibility, especially in regions where a rigid application of service and quality standards would lead to undersupply. It is the responsibility of the states to use them to maintain comprehensive, needs-based care."