What does the GKV reform mean for nursing service managers?

The GKV Contribution Rate Stabilization Act, which was passed on 10 July, fundamentally changes the financing of nursing staff. The previous cost coverage principle – under which actual expenses were refinanced retrospectively – is being replaced by an update model: the nursing budget for 2026 forms the basis for all subsequent years, but with a cap linked to the GKV's revenue development. Collectively agreed pay increases will be refinanced; any additional costs beyond that must be borne by the hospital itself. Underspending will be deducted from the hospital's budget for the following year. Premature cost-cutting is therefore not rewarded. Those who take the time to understand the law in detail will also recognize the opportunities.

What the anchor year 2026 means for your planning

2026 is the strategic anchor year on the basis of which the nursing budgets for 2027 and 2028 will be calculated. Anyone who spends too little now and in the following years will permanently reduce their nursing budget; a downward spiral begins. Decisions made in 2026 will therefore have a longer-term impact than ever before.

Here is an overview:

• High nursing costs in 2026: High anchor budget → greater flexibility in 2027 and 2028
• Low nursing costs in 2026: Lower anchor budget → permanent budget loss from 2027 onward
• Budget underspent in 2027: Budget for 2028 decreases → downward spiral For hospitals that are financially able to act, it is worthwhile to fully utilize the nursing budget in 2026. This is the only way to secure a slightly increased budget for 2027 and the following years.

How nursing service managers can make the case

In discussions with the commercial department, nursing service managers should make it clear that this legal framework rewards swift action in 2026. The goal is to fully utilize the nursing budget for 2026 and even generate additional reimbursable costs in order to raise the baseline.

Three clear recommendations:

1. Hire skilled professionals now – still in 2026 Skilled professionals undergoing recognition are also counted toward the nursing budget. The earlier they enter the country, the longer their personnel costs will have an effect in the anchor year 2026. Every month counts and increases your anchor budget for the coming years.

2. Organize entry as early as possible Time is money. Every professional who starts work in 2026 still increases the foundation of your nursing budget for the coming years.

3. Planning for 2027: Do not fall below the budget Anyone who deploys fewer nursing staff in 2027 than in 2026 will lose budget for 2028 – with no possibility of correcting this later. Plan new hires so that you remain at least at the level of the previous year's budget.

If nursing service managers act in this way, they can safeguard their permanent workforce. Of course, there are commercial arguments for restraint: for hospitals in an existential financial crisis, securing liquidity is not a matter of strategy, but of survival. But commercial management, too, should understand the downward spiral before making a decision.

Why blind cost-cutting is the wrong approach

The other factors that determine personnel planning continue to apply:

• Normal staff turnover and demographic change continue. They require new hires of around 10 % of the workforce each year – regardless of growth targets. Anyone who stops recruiting is heading toward understaffing,
• Minimum staffing levels remain relevant in certain areas. Requirements continue to apply for pediatric nursing areas (KKP) and intensive care, and falling below them can result in the loss of service groups.
• Overload comes at a cost. Declining employee satisfaction, rising sick leave, and jeopardized OR and intensive care capacities are not abstract risks – they are a lived reality in many hospitals.
• Waiting for applicants from closing hospitals is not a strategy. Nursing professionals have low regional mobility. Skilled professionals becoming available in the region rarely lead to any significant increase in applications.
• Continuity in integration pays off. Anyone who stops hiring and then ramps up again pays twice: if integration work has to be handled in peaks, the permanent workforce becomes disgruntled.

Conclusion: Precise personnel planning is more important than ever

The GKV Contribution Rate Stabilization Act makes personnel planning in nursing a strategic core task, not only for nursing management but for the entire hospital leadership. Time is running out: the later skilled professionals start work in 2026, the smaller their impact on the anchor budget.

Arrange a specific contingent with us now. We support you with fast entry and budget-effective placement in 2026.