Healthcare reform today hinges on how to set fair and sustainable financing for hospitals. It was stated that wages can no longer grow automatically regardless of performance and that the system must lean more on output and transparent data. What does this mean for hospitals and patients, and why is follow-up care also key?
Fairer funding: DRG, prus and the base rate
The discussion focuses on two pillars: DRG (payment for a hospitalization case according to diagnosis and complexity) and prus, that is a flat rate for "standby" and expected performance. Also key is CKS – the base rate used to convert the relative weights of procedures; whether money flows fairly depends on how it is set. A memorandum between hospitals, insurers and the ministry anticipates that the share of DRG will increase, over 2025–2027 to as much as 70 percent, even though no country has full DRG in place nationwide.
Open data have succeeded in sparking "interpretation wars", but they help move toward fairness among providers. There is also the impact of an extraordinary amount of 191 million euros for faculty and university hospitals, which is not yet recalculated into effective rates in 2025, but will be in 2026 – that can change the picture of comparisons. A warning was also voiced against hasty conclusions drawn from quarterly data; it makes sense to compare full years. Experience from abroad is instructive: Czechia has restarted DRG several times, and Germany, after years of a high DRG share, is looking for brakes to avoid unwanted incentives and unnecessary hospitalizations.
Less "everything everywhere," more follow-up care
The optimization of the hospital network has not yet delivered the expected concentration of procedures; rather, many facilities are trying to do everything just to survive. Experts emphasized that the goal should be safe, high-quality care, even if that may mean more travel for complex procedures and, conversely, aftercare closer to home. What is missing, however, is functional follow-up and long-term care that would free up acute beds and be cheaper and more accessible for the patient. The ministry has indicated that by the end of the year it will present a concept of follow-up care for patients after a stroke as a first step.
The transformation of some smaller hospitals into follow-up or one-day care could be a realistic solution for regions. An essential condition, however, is a strong primary sector and a clearly defined patient pathway between levels of care. A higher DRG share will also naturally create motivation: hospitals will have to work more to "earn" their reimbursements; otherwise, transformation or exit from the network looms. For the patient, this may mean a more transparent system, shorter stays in acute hospitals and more aftercare closer to family.
