The debate over the Zentralklinikum Baden-Baden Rastatt (central hospital) is the dispute about the future of hospital care in Baden-Baden and the district of Rastatt. The shareholders of Klinikum Mittelbaden gGmbH want to replace their three acute-care hospitals in Baden-Baden, Rastatt and Bühl with a single new building at the Münchfeldsee near Rastatt. For Baden-Baden, that means losing its own hospital, the Klinik Baden-Baden Balg. The argument has occupied the city council, the district council and the public since 2021 and led to a referendum in 2025.
Background
In 2021 the shareholders adopted a decision in principle to concentrate acute care at a single site in future. The hospital group cites changed legal conditions, higher quality requirements and the aim of eliminating duplicate structures. The group has so far given no reliable figures for the construction costs. For a new building, the state of Baden-Württemberg usually covers 50 to 60 percent of the eligible costs, with the shareholders bearing the rest, usually financed through loans.[1] In July 2025, the project was described as costing around 700 million euros.[2] That is not a robust cost estimate, and it may still shift considerably before construction begins.
The search for a site and the decision for the Münchfeldsee
Five plots were under consideration for the new building, two of them in Rastatt and three on Baden-Baden’s municipal territory, namely in Sandweier, in Haueneberstein and in Balg next to the existing hospital. A report by the hospital consultancy Endera rated the “Am Münchfeldsee” site in Rastatt best, and the supervisory board recommended it to the shareholders.[1]
On 25 November 2024 Baden-Baden’s city council passed the decisions in principle with 26 votes in favour, twelve against and one abstention, and Rastatt’s district council followed suit almost unanimously a day later.[1]
The conditions set by Baden-Baden’s city council
In November 2022 the city council had attached conditions to its approval of further examination of the Münchfeldsee site. It demanded that the city’s shareholding in the future hospital be adjusted to 25.1 percent, that the new building bear the name “Zentralklinikum Baden-Baden Rastatt”, and that a boundary exchange be carried out “with the result that births are possible on Baden-Baden’s municipal territory”.[1]
Financial interests lie behind the first condition. The city holds 40 percent of Klinikum Mittelbaden and therefore bears 40 percent of the losses of a group that has been running a deficit for years, most recently minus 16.75 million euros in 2024.[3] In the new operating company, Baden-Baden holds a stake of only 29.5 percent.[4]
The dispute over the place of birth
The third condition led to a procedure unusual in Germany. Because the new building stands on Rastatt’s municipal territory, children born there would have Rastatt entered as their place of birth in their papers. The then Lord Mayor Dietmar Späth therefore proposed moving the boundary and placing the delivery rooms as an enclave on Baden-Baden soil. Rastatt’s administration initially rejected this.[5]
In December 2024 the two administrations reached an agreement after all: a few square metres beneath the delivery room are to become Baden-Baden territory.[4] What matters to Baden-Baden, and to many a visitor especially from eastern Europe, is having Baden-Baden as the place of birth in one’s identity papers. In Russia and in other former Soviet states, the name Baden-Baden carries a very special significance.[5]
The 2025 referendum
Resistance to the decisions of 25 November 2024 formed in Baden-Baden. A citizens’ initiative collected signatures for keeping the hospital site in Baden-Baden and thereby secured a referendum, which was held on 29 June 2025. The question read:
Are you in favour of repealing decisions 1, 3 and 9 under agenda item 7, passed by the city council on 25 November 2024, and of the city of Baden-Baden approving the construction of a new central hospital only on condition that Baden-Baden is its location?
A yes would have tied the city’s approval to the Baden-Baden site. 45.06 percent of those voting (7,514 votes) were in favour, 54.94 percent (9,161 votes) voted no. Turnout was 39.91 percent, and the required quorum of 20 percent of those entitled to vote was met.[6] The city council’s decisions therefore stood, as did the Münchfeldsee site.[7]
State of the process
In June 2025 the shareholders founded a construction company, which was entered in the commercial register in February 2026. Its supervisory board convened for the first time in March 2026.[1] Under the schedule so far, construction is to begin in March 2029 and operations to start in 2034.[8]
At a joint press conference on 15 May 2026, district administrator Christian Dusch, Baden-Baden’s new Lord Mayor Thomas Jung and Rastatt’s Lord Mayor Monika Müller expressly committed themselves to the Münchfeldsee site. At the same time they conceded that drastically tightened federal-policy and economic conditions were forcing a reassessment of the timetable.[1]
The debate has thus shifted. The pressing question is no longer the site, but whether the group can survive economically in the years before the new building. On 12 June 2026 the staff, together with the political leadership and the nursing alliance, held a day of action under the motto “Kein Geld. Keine Versorgung. - Wir sind für Sie da. Solange wir noch können” (“No money. No care. - We are here for you. As long as we still can”).[1]
References
- ↑1.1↑1.2↑1.3↑1.4↑1.5↑1.6↑1.7 #ZukunftKMB, Klinikum Mittelbaden, retrieved 12 July 2026 (Archived)
- ↑ “Wirtschaftliche Lage verschärft” - Zentralklinikum Mittelbaden erneut auf dem Prüfstand?, SWR Aktuell, 3 July 2025, retrieved 12 July 2026 (Archived)
- ↑ Beteiligungsbericht 2024 des Landkreises Rastatt, Landkreis Rastatt, pp. B-28 to B-34, retrieved 11 July 2026 (Archived)
- ↑4.1↑4.2 Kommt das Zentralklinikum nach Rastatt oder doch nach Baden-Baden?, Staatsanzeiger für Baden-Württemberg, 13 December 2024, retrieved 12 July 2026 (Archived)
- ↑5.1↑5.2 Wie in Baden-Baden weiter Kinder geboren werden, Staatsanzeiger für Baden-Württemberg, retrieved 12 July 2026 (Archived)
- ↑ Baden-Baden stimmt für das Zentralklinikum Rastatt, Staatsanzeiger für Baden-Württemberg, retrieved 11 July 2026 (Archived)
- ↑ Fragen und Antworten zum Ablauf des Bürgerentscheids im Überblick, Klinikum Mittelbaden, retrieved 11 July 2026 (Archived)
- ↑ Bürgerentscheid Baden-Baden: Klinikum Mittelbaden kann in Rastatt bauen, kma Online, retrieved 12 July 2026
Web links
- #ZukunftKMB - the hospital group’s information page about the new building