Empty beds in the corridor: aren’t there enough patients or are there no nursing staff?
Photo: imago/MiS
Another gloomy prognosis: the hospital rating report did not bring any good news about the economic situation of inpatient care this year either. The balance sheets of almost 1000 hospitals from 2021 were included in the analysis published a few days ago on around 240 pages, which is 70 percent of the total number. The report has been published for almost 20 years by the RWI Leibniz Institute for Economic Research in Essen, among others.
One of the depressing results of the study is that if the income statements from 2021 to 2023 are continued this year, 18 percent of the hospitals are threatened with bankruptcy, and in 2030 even 44 percent. Mind you, if nothing changes in the framework conditions, if there is no reform, but instead there would be progressive unfavorable demographic development. At the end of this year, 47 percent of the houses were not in the black, and in 2030 even 58 percent.
Since the beginning of the pandemic, hospitals have had a total of 13 percent fewer patients. In 2021, the general hospitals with their 437,000 beds were only 66 percent occupied. Overall, that seems to remain the case, even if one of the reasons – namely the fear of infection with Sars-Cov-2 – has all but disappeared. For the clinics, this means that they have less revenue while their costs are rising, including for energy.
The authors of the report believe that 85 percent utilization is a realistic goal. If outpatient treatment progressed at the same time, there would ultimately be a need for 310,000 beds, and an estimated 1,165 hospitals would then be sufficient. According to report co-editor Boris Augurzky, even with that number, patients still had choices. Standard sizes of the hospitals that make economic and structural sense would also be achievable. This calculation is still below the number of 1250 that the National Association of Statutory Health Insurance Funds recently considered necessary in its own scenario.
In contrast to the acute pandemic times, there will also be no more state aid in the foreseeable future, i.e. no rescue package. In addition, there is a continuing shortage of staff, now well beyond the nursing professions. Hospitals are therefore under pressure to make decisions themselves, apart from reforms.
The dilemma can actually only be resolved with a reform. Economists like Augurzky still consider such a controlled “market adjustment” to be better than a “cold” structural change. With this, more and more hospitals would have to close year after year for economic reasons if their owners did not support and renovate or restructure them.
With the hospital reform project of Federal Health Minister Karl Lauterbach (SPD), it is already foreseeable that politicians will act. However, it is still unclear at the moment how exactly this should look like, and even less what effect the undertaking will have. With its current title »The Revolution?!«, the rating report also puts this question mark.
One of the trends that the reform will also address is the increasing proportion of outpatient medical services. In international comparison, Germany lags behind, and the numerous short or one-day stays in this country are not always objectively justified. But they cost, among other things, care work time. Health economist Augurzky explains that 20 percent of the services still provided on an inpatient basis could also be performed on an outpatient basis, “conservatively estimated”.
But it is not only here that politicians have to react with their reform efforts. Ideas for eliminating the shortage of staff should also be incorporated so that the opportunities of digitization that have been missed so far are finally seized. All of this can only be implemented with political compromises, because the sovereignty for the hospital planning, which urgently needs to be improved, lies with the federal states. If you look at the location of the clinics, Baden-Württemberg and Bavaria have the highest proportion of hospitals that make losses at over 40 percent. On the other hand, the Free State of Saxony is the leader with the most economically healthy facilities: 86 percent of the clinics there ended 2021 with a profit. Over 70 percent was also achieved in the federal states of Berlin, Brandenburg, Hamburg, Mecklenburg-Western Pomerania, Hesse, North Rhine-Westphalia and Schleswig-Holstein.
On the occasion of the rating report, the German Hospital Society called for at least one preliminary law to compensate for inflation. Without this, most houses would no longer experience the announced reform. The total revenue increases of 6.5 percent for 2022 and 2023 are insufficient with a 17 percent price increase during this time. The hospitals got into debt by a further 600 million euros month after month.