Countries challenge hospital construction policies in legal dispute

In a significant move, the Ministries of Health of Baden-Württemberg, Schleswig-Holstein, and Saxony-Anhalt have filed a lawsuit against the Joint Federal Committee (G-BA) with the Federal Constitutional Court. The legal process, which began around 2025, aims to review the constitutionality of G-BA regulations on minimum quantities and staffing in hospital care.

The lawsuit is a necessary last resort, according to Baden-Württemberg's Minister of Health, Manne Lucha. The crux of the matter is the G-BA's interference with the states' responsibility for ensuring inpatient care, which, in Lucha's view, effectively undermines their authority.

The G-BA has been increasing minimum quantities for certain treatments, such as allogeneic stem cell transplantation, without sufficient evidence from the states' perspective. For instance, the minimum quantity for transplants has been raised from 22 to 40 for the year 2025. This could potentially lead to sanctions from 2026, which may force hospitals and specialist departments to close or restrict their supply for regular care.

The lawsuit also targets the minimum staffing requirements for stationary psychiatric and psychosomatic facilities. The states fear that these requirements, if implemented rigidly, could lead to shifts and gaps in care due to chronic staff shortages.

Health Minister von der Decken of Schleswig-Holstein and Petra Grimm-Benne of Saxony-Anhalt share Lucha's view. Grimm-Benne wants to have the current minimum quantity and personnel requirements of the G-BA reviewed to see if they are compatible with the responsibility of the states for adequate hospital care.

The legality of the Mm-R and the PPP-RL of the G-BA under the aspect of planning sovereignty of the federal states is being discussed in an expert opinion on behalf of the state of Baden-Württemberg. The G-BA has refused to engage in a genuine discussion about the appropriate minimum quantity in this area.

The states argue that their expertise in hospital planning is crucial and superior to that of the G-BA in addressing care problems in the respective federal states. They believe that specialization and concentration of highly complex services are indispensable components of modern hospital planning, but the states must still be able to act flexibly to ensure care while considering regional conditions.

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