According to experts, medical care in Germany will deteriorate noticeably. Representatives of the medical profession and hospitals see the main reason for this as misguided health policy on the part of the coalition government. The wave of hospital bankruptcies that has been feared for months is now underway. According to a survey by the German Hospital Institute (DKI), almost 70 percent of German hospitals believe that their existence is at risk in the short or medium term.
Key takeaways
1
Experts blame flawed government policy for Germany's healthcare crisis, which is causing widespread hospital and clinic closures.
2
The Health Minister's controversial reform is considered too slow to help and risks making the system's collapse even worse.
3
Critics accuse the Minister of pushing a state-run healthcare agenda that will ultimately reduce patient access to medical care.
Commentary By:
Frank Rudolph
Frank Rudolph has many years of experience in the calculation and billing of medical services. As managing director of the Federal Association of Health Clearing Houses (BVVG), he is familiar with the consequences of health policy decisions at federal and state level for the medical care of the population – particularly with regard to the cost-benefit ratio. Born in Essen, the business economist is a member of the CDU/CSU's SME and Economic Association. From 2007 to 2013, Rudolph was a member of the Federal Health Commission. Since 2007, he has been 1st Deputy Chairman of the CDU NRW's Health Policy Working Group.
Painful cramps and a fever of almost 40 degrees Celsius. The emergency services wave you away: it's not serious enough. The medical on-call service's phone is constantly busy. The nearest hospital? Two hours away by car. Waiting time there? At least five hours. The family doctor? Closed her practice two months ago. No successor in sight. Appointments with a specialist? Ask again next year. We may still be a long way from such horror scenarios. But the downward spiral into which Germany's healthcare system has fallen due to misguided policies is gathering momentum.
Many hospitals are looking to the future with concern. At the same time, they view the hospital reform promoted by Federal Health Minister Karl Lauterbach (SPD) with great skepticism, according to a survey by the German Hospital Institute (DKI). According to the survey, almost 70 percent see their existence threatened in the short or medium term.
Hardly a week goes by without bad news: “Kiel City Hospital: Dramatic situation,” “Hospitals in financial distress: Alarm level dark red,” “Sharp rise in hospital insolvencies,” “North Rhine-Westphalia: Nine hospitals have already filed for insolvency proceedings.” No less disturbing is the news from the private practice sector: “Berlin doctors lament the demise of private practices: Healthcare in acute danger,” “Outpatient care at risk,” “1,100 doctor positions vacant in Baden-Württemberg,” “Nationwide shortage of 4,000 family doctors.”
The long series of negative headlines makes it clear that Germany's healthcare system is experiencing a painful decline. Tens of thousands of patients with statutory health insurance between Rügen and the Black Forest, between the Alps and the North Sea, are already feeling the consequences. Hospital directors and association officials, doctors' and patients' representatives, state governments, and many health policymakers are sounding the alarm bells.
In recent weeks, thousands of hospital employees have taken to the streets to vent their anger. Tens of thousands of citizens have also protested against hospital closures and the demise of medical practices. At the beginning of October, doctors across Germany responded to a call from the Virchow Association and closed their general and specialist practices for several hours. The “Praxis in Not” (Practices in Distress) protest campaign continues, with further temporary closures being planned.
“Practices are now so strangled by a wide variety of regulations, and in particular by restrictions on billing options, that they are having to cut back on services because they can no longer finance them,” says Virchowbund chairman Dirk Heinrich, an ENT doctor.
Several interest groups are participating in the protests, including associations representing surgeons in private practice, ENT specialists, dermatologists, orthopedists, trauma surgeons, gastroenterologists, and the German Association of Medical Specialists.
How is the Federal Ministry of Health responding? With a mixture of ostrich tactics (burying its head in the sand), dismissive responses, empty phrases, and deception. Meanwhile, Lauterbach, with blinders on and foam at the mouth, is trying to push through his still controversial hospital reform.
Warnings from those affected are being ignored. These include warnings from Roland Ventzke, managing director of the struggling municipal hospital in Kiel: “We find ourselves in a dramatically difficult economic situation for hospitals. And Mr. Lauterbach is shifting the entire issue onto the reform, which will not take effect until 2026.”
By then, one thing is certain: many of the clinics that currently provide medical care to tens of thousands of people will no longer exist. According to figures from the German Hospital Federation (DKG), 26 operators with a total of 34 hospitals filed for bankruptcy within a period of just under a year, starting in November 2022.
In several cases, bankruptcies were avoided because local municipalities stepped in to save the day. But that hardly changes the downward trend. According to a survey of the 600 largest German hospitals conducted by management consultancy Roland Berger, more than half are in the red. “We are indeed at the beginning of an uncontrolled wave of hospital closures,” Lauterbach admitted in an interview with BILD in the summer. He added: “Without the reform, 25 percent of hospitals would probably close.”
This is nothing more than speculation, the accuracy of which no one can seriously verify at present. It would be equally reasonable to assume that the reform, which the minister has touted as a “revolution,” will make things much worse—and that far more than a quarter of hospitals will fall by the wayside.
At least there is one consolation: thanks to the Hospital Transparency Act recently passed by the Bundestag with the support of the traffic light coalition majority, patients will in future be able to find out more easily about the treatments offered and quality standards of the remaining clinics on a central internet platform.
In reality, this new online quality atlas is as superfluous as a goitre. There are already many ways to find out about the quality of hospitals and the treatments they offer. And even today, no one who needs complicated cancer surgery would go straight to the nearest rural hospital, but would instead look for clinics that specialise in this field.
The new “transparency” is, of course, controlled by the BMG. This is unmistakably another step toward state dirigisme. To this end, another bureaucratic monster is being created at the expense of taxpayers. “Contrary to the minister's repeated announcements that he would ensure less bureaucracy, new reporting requirements with no added value are being created at great expense,” criticizes Gerald Gaß, CEO of the German Hospital Association (DKG).
The ministry is responding to the challenge posed by the decline in medical practices in a manner that is equally unrealistic. One thousand so-called health kiosks are intended to address the issue and replace the outpatient care that is disappearing in many places. However, Lauterbach is unable to provide either solid financing for this impractical idea or a comprehensible explanation of how these facilities are to be staffed.
There is concern that in future, “community nurse Monika” – well known from GDR times – will replace the family doctor in many places. Union politicians such as Bavaria's acting health minister Ulrike Scharf are siding with the protesters: “We need stable practices ... not expensive parallel structures such as health kiosks.”
The CDU and CSU share concerns about a “cold structural adjustment” and are calling for hospitals to be financially protected by a preliminary law before the hospital reform is implemented in practice, to prevent them from going bankrupt as a result of the burdens caused by the COVID-19 pandemic, increased energy prices, and high inflation. Lauterbach's office has responded to this with a shrug of the shoulders.
Not only hospitals, but also independent healthcare professionals are complaining about political mismanagement. Their umbrella organizations have issued an urgent appeal to the federal government to change course in healthcare policy. Otherwise, there will be a noticeable deterioration in nationwide healthcare provision as early as spring 2024, warned Andreas Gassen, chairman of the National Association of Statutory Health Insurance Physicians (KBV).
Will the warnings have any effect? Hardly, as long as Chancellor Olaf Scholz (SPD) allows his comrade, the health minister, to continue unchecked. It is common knowledge that Lauterbach is pursuing his own agenda.
The chairman of the Virchow Association, Dirk Heinrich, outlined this agenda in an article for the Frankfurter Allgemeine Zeitung newspaper: Lauterbach's “common thread” as a long-standing SPD health politician leads directly to a state-run healthcare system including “citizens' insurance” as a single state health insurance fund.
Heinrich goes so far as to accuse the minister of deliberately depriving medical practices of funds, for example by abolishing the new patient regulation, which had enabled faster treatment for newly ill patients. This is no coincidence, he says, but part of a strategy. The goal: “Primary care in municipal primary care centers by community nurses and the remaining family doctors, specialist care on an outpatient and inpatient basis at hospitals.”
Ultimately, this amounts to a creeping nationalization of the German healthcare system. Lauterbach has been laying the groundwork for this since he was appointed to office by Scholz in 2022. We are already seeing the first consequences of this type of healthcare policy. Heinrich describes the result as follows: "Everything will be reduced. Fewer doctors, less medicine, and fewer appointments are the foreseeable consequences. In any case, it will not lead to better health." Will voices like these ever be heard in the Chancellery?