Appeal to federal, state and local governments

Hospital reform: Secure the future of non-profit hospitals!

The current hospital reform and the continuing precarious financial situation threaten the existence of non-profit hospitals. A rethink is needed!

Michael Herm, Eva Bolta
Carina Kircher
December 14, 2023
Reading time
4 Min.

Many hospitals in Germany are facing closure. Due to the requirements of the Hospital Remuneration Act, revenues can hardly be increased and are no longer sufficient to cover costs, which have risen disproportionately to inflation. The financial situation of non-profit hospitals is particularly worrying. They face similar economic challenges to municipal hospitals, but do not receive the same level of political support.

Yet in many communities, reliable and sustainable healthcare would be unthinkable without non-profit hospitals. In Stuttgart, for example, 40 percent of the available hospital beds are provided by three large non-profit organisations: the Robert Bosch Hospital, the Marienhospital and the Diakonie Hospital. That's 2,254 beds and around 6,900 employees.

In a recent appeal, the three large non-profit hospitals are therefore calling for all hospitals to be provided with public tax money so that they can fulfil their care mandate. This is also the conclusion of a recent legal opinion commissioned by the associations of non-profit hospitals in Germany.

Our Appeal

It is a fundamental human need to receive appropriate, high-quality care when you are ill. Over the past 100 years, not-for-profit hospitals have proven their ability to deliver, regardless of political changes. This success story must not be jeopardised by financial bottlenecks and unilateral reform proposals.

The non-profit hospitals in Stuttgart are an important part of the healthcare system and deserve the support of the federal, state and local authorities. We hope that our appeal will be heard and that the future of the non-profit hospitals will be secured.

The planned hospital reform makes the situation even worse. Each of the three large non-profit hospitals in the Stuttgart region has outstanding, in some cases internationally recognised, expertise in various fields. This benefits the quality of patient care. However, these specialities are in danger of being undervalued in the forthcoming hospital structural reform.

What is the significance of hospital reform?

The healthcare system as a whole is no longer financially viable in its current form - reform is urgently needed. On 10 July, the federal and state governments agreed on a key points paper for hospital reform. The Federal Ministry of Health is now working on a draft bill. It is clear that this will fundamentally change the hospital landscape. Three goals are to be achieved:

- Ensuring the safety of care, 
- securing and improving the quality of treatment, and 
- reducing bureaucracy.

The current system of per-case flat rates is to be replaced by so-called retention flat rates. Hospitals will receive these for offering certain services - not for the services provided. Federal Health Minister Karl Lauterbach hopes that this will ensure high-quality care and reduce the economic pressure on hospitals. However, the number of hospitals in Germany is to be significantly reduced as part of the reform. The new classification of hospitals into so-called service groups will focus on high-performance centres of excellence.

[DE Copy] Wie gehören Krankenhaus und Stiftung zusammen?

The Robert Bosch Stiftung is a charitable foundation that operates the Robert Bosch Hospital. The hospital is part of the Bosch Health Campus, which brings together all the foundation's healthcare activities and facilities: patient care, biomedical research, medical and nursing education, and the promotion and testing of promising new ideas for better healthcare.

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