Hospital Reform in NRW: Legal Challenges Emerge as New Policies Take Effect

Effective April 1, a new healthcare plan aimed at restructuring hospital services will be implemented in North Rhine-Westphalia (NRW). This reform marks NRW as the first state to adopt the hospital reform initiative proposed by Federal Health Minister Karl Lauterbach.

The reform transitions from a traditional model based on bed capacity to a system focused on performance groups (PG). Hospitals will now be permitted to offer certain medical services only if they meet specified quality standards. This approach aims to ensure that patients receive treatment for complex procedures at specialized facilities while maintaining widespread basic and emergency care.

In a recent legal development, the University Hospital Essen successfully contested a planning decision from the NRW Health Ministry that would have restricted the facility from performing heart transplants. The administrative court recognized the hospital's leadership in transplantation research and education, indicating that such a ban would jeopardize ongoing studies in the field.

Since the announcement of the new hospital plan, a wave of legal actions has emerged, with over 95 lawsuits and 28 urgent applications filed by various hospitals against the health ministry's decisions regarding performance group allocations. Most of these cases have been dismissed, but hospitals are striving to retain specific services amidst the new regulations.

Opposition parties have criticized the government's approach, describing it as chaotic and claiming that hospitals were not granted adequate time to adjust to the changes. The deputy leader of the SPD parliamentary group, Lisa-Kristin Kapteinat, emphasized the need for a more orderly implementation process, noting that federal law allows until the end of 2026 for such reforms to be fully realized.

NRW's government has been working on this restructuring for three years but postponed the implementation by three months due to hospital complaints. The government has pledged that 90% of the population will have access to basic and emergency care within a 20-minute travel time, which is more stringent than the national standard of 30 minutes. Experts, however, are skeptical about potential shortages in rural areas due to existing financial difficulties, as 17 hospitals have closed in the last four years.

The basic services in NRW will include performance groups for general internal medicine and general surgery, where operations will largely continue as before. Significant modifications will occur in other areas, such as knee and pancreatic surgeries, which will see a concentration of services. The increased financial incentives for knee replacements have raised concerns that hospitals may prioritize these procedures even when unnecessary.

A notable exception in the reform is the expansion of services in child and adolescent psychiatry, a response to the rising demand since the COVID-19 pandemic. However, health experts express doubts about the feasibility of these plans due to a shortage of qualified personnel.

The ongoing legal disputes focus on individual decisions rather than the overall necessity of the reform, which is broadly supported by health stakeholders and unions alike. The objective is to enhance quality through specialization, leading to improved treatment outcomes as a result of higher patient volumes, as explained by Robert Grützmann, Director of Surgery at Erlangen University Hospital. He highlights that centralizing complex procedures has been shown to reduce mortality rates and improve long-term results.

Nonetheless, there are concerns about whether the remaining hospitals can manage the increased patient load and whether the reduction in decentralized surgical opportunities might hinder surgical training and education.

The service union Verdi has raised alarms about the potential impact of the reform on hospital staff, highlighting existing issues of workforce shortages and excessive workloads. The union's health sector lead in NRW, Susanne Hille, warns that any restructuring must ensure that new systems are sustainable before dismantling old ones to avoid creating gaps in care that could adversely affect both staff and patients.

Despite these challenges and pending lawsuits, the NRW government is proceeding with the implementation of the reform, including at the University Hospital Essen. The ruling is not yet final, as the main proceedings are still pending and an appeal may be filed with the Higher Administrative Court. Until then, the new state plans will apply to the hospitals involved in the legal actions.