> because Germany is federal-social-democratic, not stalinist

Ah, "federal" is the right answer here. In many smaller EU countries, there is a single central social-democratic government, which can just fund an open-source solution for all regions to use.

well we can fund an OSS, but i have this feeling you underestimate the complexity of all possible hospitals.

I probably do. In any case, I would design a fundamental core system with an open API for extensions, that could be developed and maintained by third-parties, based on additional requirements by each hospital.