Promises of Progress, Risks of Exclusion: The Krankenhausreform and the Future of Universal Health Coverage in Germany

Thömmes, Annika (2025) Promises of Progress, Risks of Exclusion: The Krankenhausreform and the Future of Universal Health Coverage in Germany. Bachelor thesis, Global Responsibility & Leadership (GRL).

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Abstract

Germany’s healthcare system, long regarded as one of the most comprehensive in the world, is currently undergoing one of its most significant structural reforms through the introduction of the Krankenhausreform, implemented by the Krankenhausversorgungs- verbesserungsgesetz (KHVVG) in January 2025. This policy reform was launched in response to growing inefficiencies, rising healthcare costs and financial strain, particularly among hospitals in rural areas. The reform introduces four major policy instruments, namely the establishment of 65 standardised service groups (Leistungsgruppen), the creation of cross-sectoral care facilities (Sektorenübergreifende Versorgungseinrichtungen), a federally funded transformation fund and a shift from volume-based to capacity-based hospital remuneration (Vorhaltevergütung). This study analyses the KHVVG through a qualitative policy analysis framework using Walt and Gilson’s health policy triangle and the WHO’s health system building blocks. It assesses the reform’s implications for universality, accessibility, financing, and sustainability in the context of people-centred healthcare. The findings suggest that while the reform aims to address long-standing structural issues by consolidating services and improving coordination, it also raises critical concerts. Service centralisation may lead to increased travel burdens for rural patients, which undermines equitable access. Furthermore, capacity-based remuneration may not sufficiently compensate smaller or non-profit hospitals, especially when service groups are redistributed unevenly across facilities. Although the reform holds potential to modernise the system and promote integration between outpatient and inpatient sectors, its success will depend on careful implementation, sufficient funding and ongoing evaluation. The lack of clarity in some legislative provisions and the absence of strong empirical foundations further highlight the need for cautious optimism. Future research should focus on regional disparities, stakeholder experiences and the long-term sustainability of the reform’s financial model. This study contributes to ongoing debates about the balance between economic efficiency and equitable, high-quality care in a complex federal healthcare system.

Item Type:	Thesis (Bachelor)
Name supervisor:	Rotulo, A.
Date Deposited:	06 Jun 2025 08:44
Last Modified:	06 Jun 2025 08:44
URI:	https://campus-fryslan.studenttheses.ub.rug.nl/id/eprint/599

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