At the end of last week, the Bundestag and Bundesrat approved further financial measures that will place additional strain on German hospitals in 2026. As a result, hospitals will bear almost the entire cost of a €2 billion savings package for the statutory health insurance system (GKV)—about €1.8 billion.
To achieve this, the most-favoured-nation clause (Meistbegünstigungsklausel), which was introduced around two years ago to protect hospital remuneration, will be suspended on a one-off basis for 2026. This decision places further pressure on hospitals at a time when many are already facing significant financial distress.
That said, the concerns raised by the federal states (Länder) and hospital representatives have not gone entirely unheard. The reduction in hospital remuneration via the state base case value (Landesbasisfallwert)—the mechanism governed by the most-favoured-nation clause—is not intended to extend beyond 2026, at least not in full. From 2027 onwards, the basis for negotiations on the state base case values is set to increase by 1.14%. To ensure uniform application across the sector, psychiatric and psychosomatic hospitals will also be included in this adjustment.
It is now essential that the decisions taken by the Bundestag and Bundesrat are rapidly enshrined in law—specifically within the Federal Nursing Care Rates Ordinance (Bundespflegesatzverordnung) and the Hospital Reform Adjustment Act (Krankenhausreform-Anpassungsgesetz). This would provide hospitals with greater planning certainty, both for 2026 and for the years that follow.
Strategic Implications for Hospital Management
From a broader perspective, short-term funding cuts of the kind currently being implemented are highly detrimental to the strategic decision-making required of hospital management—particularly during a period of profound structural reform. The substantial financial reductions approved for 2026 risk accelerating so-called “cold” structural changes, ultimately to the detriment of patient care.
Moreover, relief for GKV expenditure would be most effectively achieved by financing non-insurance benefits through general taxation. At the same time, many of the anticipated cost increases in 2026—especially within the hospital sector—are themselves a consequence of excessive regulation and bureaucratisation introduced by previous legislation.
Given that several stakeholders have already signalled the likelihood of further substantial savings measures in the healthcare system for 2026, there is growing concern that the Federal Ministry of Health (BMG) and legislators will prioritise a coherent, well-planned hospital structural reform. Without such a commitment, there is a real risk that short-term legislative initiatives and additional savings packages will quickly erode the positive effects of the recently introduced immediate transformation funding—potentially as early as next year.
Background
On 21 November, the Bundesrat formally referred the matter to the Mediation Committee of the Bundestag and Bundesrat (21/2893), citing disagreement over the regulation of hospital remuneration for 2026. The compromise reached within the joint committee limits the financial impact of abolishing the most-favoured-nation clause to 2026.
To prevent negative consequences for hospital financing in subsequent years, negotiations on the state base case value for 2027 will be based on a 2026 value increased by 1.14%. This adjustment can be implemented through an amendment to the Hospital Remuneration Act (Krankenhausentgeltgesetz). Once again, psychiatric and psychosomatic hospitals must be included to ensure sector-wide applicability.
In a formal protocol statement, the Federal Government has also committed to amending the Federal Nursing Care Rates Ordinance accordingly.
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
