Germany’s hospitals entered this year’s 48th German Hospital Congress in Düsseldorf with a mixture of concern, fatigue, and diminishing confidence in national health policy. Despite the event’s optimistic motto – “A Fresh Start for Hospital Policy – Courage to Change” – the prevailing mood among hospital executives was far from upbeat. After three years of worsening financial conditions and rising structural pressures, many arrived expecting political clarity. What they heard instead was confirmation that the core of the government’s reform will remain largely untouched.
Minister Warken: “There Will Be No Fundamental Concessions”
In her opening speech, Federal Health Minister Nina Warken emphasised that the government would only consider minor amendments to the Krankenhausreformanpassungsgesetz (KHAG), the adjustment law supporting Germany’s major hospital reform.
“There will be no fundamental concessions on the reform,”
Warken stated.
“Quality must improve, especially in complex procedures, and that means concentrating services where expertise exists – even if this results in longer travel distances for patients.”
She emphasised that minimum standards for staffing, equipment and quality across service groups would remain unchanged. While the law allows for “more exceptions, more cooperation and more flexibility for the Länder”, these would be tightly controlled and subject to agreement with statutory health insurers.
Warken described the law as “a good compromise”, insisting that the reform must not be allowed to “get off to a false start”.
Hospital Expectations: A Promised Reset That Failed to Arrive
Hospital leaders expressed deep disappointment.
At the morning press conference, Dr Gerald Gaß, President of the German Hospital Federation (DKG), noted that hospitals had hoped for a meaningful political reset after the federal election – one that reflected the realities of Germany’s strained healthcare system.
Instead, they were “disillusioned to find no genuine dialogue” between federal government, Länder and hospital operators during the development of the KHAG.
Dirk Köcher, President of the Association of German Hospital Directors (VKD), was even more direct:
“Our mission is patient care. And we now see that mission as being under threat.”
According to Köcher, the motto of the congress should not be “courage to change”, but “courage to make the right changes.”
The €1.8 Billion Cut: A Critical Blow to Fragile Finances
Any remaining optimism was further shattered by the recently announced statutory health insurance savings package, which cuts €1.8 billion from hospital funding.
This follows an earlier one-off inflation relief payment of €4 billion for 2022–2023 – relief that has now been almost halved overnight.
Because the €1.8 billion reduction lowers the funding base, the entire inflation relief will be fully absorbed by early 2028.
Minister Warken argued the issues were “two separate matters.” Hospital leaders strongly disagree.
“Cold Structural Change”: The VKD’s Stark Warning
For the VKD, these financial cuts are not isolated events but part of a three-year pattern of unpredictable, politically driven reductions.
Köcher reminded the press that in December 2022, a key protective clause in the Hospital Remuneration Act was abolished without consultation.
That provision would have increased hospital base rates during periods of reduced activity – precisely what hospitals experienced after the COVID-19 pandemic.
“Hospitals were given transformation funding only for part of it to be clawed back weeks later,” Köcher said.
“This is not reform. This is cold, because unplanned – and therefore harmful – structural change. In plain language: hospital death.”
He listed unresolved issues in the current reform framework:
dysfunctional readiness financing (Vorhaltefinanzierung)
financially damaging Hybrid-DRG regulations, introduced at the last minute
the still undelivered bureaucracy reduction reform promised for years
These, he warned, will lead to massive misdirection within the hospital landscape.
Rising Insolvencies: Systemic Pressures Deepen
The 2025 Hospital Report paints a stark picture:
61 hospital insolvencies between July 2022 and October 2024
escalating wage costs
rising prices for medical supplies
declining revenues
increasing regulatory and documentation burdens
Closures of hospitals, departments and sites are already forcing patients to travel further, eroding regional access to care.
“Some call it necessary structural reform,” Köcher said.
“We call it cold structural change.”
Call to Government: Trust Local Decision-Makers
Köcher urged political leaders to restore trust in hospital professionals:
Give local hospital leaders more autonomy
Reduce burdensome and impractical documentation requirements
Examine practitioner-led recommendations seriously
Strengthen—not constrain—local decision-making
Hospital directors, he said, fully understand that the upcoming transformation will be challenging and may involve difficult decisions. But to navigate these changes, clinics need political backing, not further destabilisation.
Crisis Preparedness: Expectations Without Funding
On the congress's second day, the VKD is hosting a dedicated session on crisis resilience.
Hospitals are increasingly expected to prepare for natural disasters, cyberattacks, mass-casualty events and national defence scenarios. But the investments required — structural, technical, operational and educational — far exceed what most hospitals can afford.
“Allowing cold structural change to continue undermines not only hospital reform goals but also emergency resilience,” Köcher warned.
“It is a dangerous strategy that ignores the complexity of what hospitals confront.”
Strong Engagement at Medica Despite Policy Turmoil
Despite the tense policy backdrop, the VKD stand at Medica was once again a major draw.
Visitors included hospital executives, association partners, industry representatives and a large student group from Osnabrück University of Applied Sciences.
VKD Managing Director Dr Jens-Uwe Schreck welcomed numerous guests on the first day alone.
A group photograph featured leaders from across the German healthcare sector, including Minister Warken and representatives of the DKG, VLK, DBfK, the NRW Ministry of Health, VKD, and Messe Düsseldorf.
A System Under Pressure – and Running Out of Time
The message from Germany’s hospital leadership is unequivocal:
Without substantial changes to the KHAG, the reform cannot achieve its political goals.
Instead, Germany risks accelerating unplanned structural collapse, shrinking care capacity and undermining crisis readiness — consequences that would be felt across the entire healthcare ecosystem.
Hospitals stand ready to reform.
What they urgently need now is political courage to make the right changes.
Original Press Release: This is a translated version of the original German press release. To view the original text, Click Here (German).
Image Credit: VKD
