The published figures first of all show very clearly that an increase in the number of treatments does not automatically lead to an improvement in a hospital's economic situation. This is precisely where one of the major challenges of hospital financing lies.

I cannot and do not wish to comment here on the internal decision-making processes of my employer. What I can say, however, based on my professional experience in budget management, is that budget decisions in a hospital fundamentally result from the interaction of many factors.

This includes changes in activity, medical needs, staff and non-personnel costs, the legal framework, investments, and above all, the question of which services are actually reimbursed under existing payment systems.

My own function is mainly situated at the interface between service delivery, financing, and negotiation. We analyse changes in activity, we prepare budget and reimbursement negotiations, and we deal, for example, with the financing of new diagnostic and treatment methods or other special services.

It is precisely there that we see very clearly that medical needs and financing must be linked. A service may be medically sensible, but it still must be clarified how it will be funded and agreed with payers.

For me, good budget management therefore does not mean spending as little money as possible. It means linking medical reality, the legal framework, and financial sustainability.

The actual strategic decisions of a large hospital company are, of course, made at the appropriate management and decision-making levels. My task, within my area of responsibility, is to help prepare the technical and financial basis for them.

Efficiency is not inherently negative. On the contrary. Precisely because resources are limited, we have a responsibility to use them wisely. Just because a process has evolved over the years does not mean it is automatically a good process.

The situation becomes problematic in my eyes when efficiency no longer means avoiding unnecessary processes, but when necessary care comes under pressure.

When employees have to permanently compensate for missing structures, when there are no more reserves, or when economic pressure leads to the time dedicated to patients becoming increasingly reduced, a limit is reached.

This limit can be assessed objectively to some extent, for example through quality, patient safety, staff workload, waiting times, or medical outcomes. But not everything can be captured by a single indicator.

My experience in intensive care is very clear: a system needs reserves. In an intensive care unit, a one hundred percent utilisation of all resources would not be a sign of maximum efficiency. It could become a problem as soon as the next emergency case arises.

That is why financial sustainability and quality of care go hand in hand for me. The best efficiency is not maximum operational intensity, but an organisation that reduces waste while retaining enough stability when care needs suddenly exceed what was planned.

The nursing care budget was an important step, because it allows nursing care to be funded differently than in the past. But developments also show that money alone does not solve the problem.

I myself worked in nursing care for many years. The workload does not arise exclusively from how many posts are funded. What is also decisive is what actually happens during a shift.

How much time does a nurse spend with the patient, and how much time with documentation, phone calls, organisational tasks, searching for equipment, or processes that could potentially be organised differently? How reliable is the schedule? How well do interfaces between teams and departments work? How well are teams led? What tasks actually need to be performed by highly qualified nursing staff?

If we want to strengthen nursing care, we must therefore not only ask: how much money are we spending? We must equally ask: what are we using these people's valuable time for?

More staff is important. But in addition, processes must improve, digitalisation must genuinely relieve the burden, and tasks must be distributed sensibly.

Ultimately, a simple question should be decisive: does additional funding translate into better working conditions and more time for patients? Only then is it truly effective.

I find the basic idea of the reform understandable. Hospitals generate considerable costs simply by maintaining care capacities. If maintaining this capacity is funded more independently of the actual number of cases in the future, this can fundamentally reduce the immediate economic pressure to generate additional cases.

However, from my experience in budget management, it is important to note that economic incentives do not disappear with a new payment system; they change. In the future too, everything will depend on how budgets for maintaining capacity are calculated, which services are assigned to a hospital, and under what conditions they are financed.

A central point for me is the service groups. They are intended to link financing more closely to structural and quality requirements. I find this fundamentally sensible, because not every medical service needs to be offered at every hospital.

When a team regularly performs a specific intervention, has the necessary staffing and technical resources, and meets defined quality requirements, routine, experience, and well-established processes can develop. Simply put: when a specific intervention is performed very regularly, the experience is different from when it is performed only a few times a year.

Concentrating procedures can therefore be a tool for quality assurance.

At the same time, this concentration must not lead to necessary care becoming less accessible for patients. Especially outside large urban areas, the question must always be answered as to how reliable basic and emergency care can be guaranteed.

The fact that around 40% of funding will remain linked to activity also shows that the number of cases will remain economically relevant. That is why I would not expect the reform to completely eliminate volume pressure.

What will be decisive, rather, is whether it more closely links economic incentives to quality of care, sensible specialisation, and reliable maintenance of capacity.

In my view, the reform would be successful if hospitals could sustainably finance the necessary structures, without having to remain financially stable exclusively through additional cases, and if, at the same time, patients benefit from receiving services where the corresponding experience, equipment, and quality are actually present.

The reform should therefore not only change how money is distributed. It should help align financing and quality more closely.