European Union of Private Hospitals

Interview with Dr. Gerald Gaß, Chairman of the Board of the German Hospital Federation (Deutsche Krankenhaus Gesellschaft)

Inflation, end of Corona aid, staff shortages – how serious is the situation for German hospitals today?

The situation is very serious. After the burdens of the pandemic, hospitals are now being hit by inflation and especially by the extreme rise in energy prices. The hospitals cannot pass on these cost increases because of the state-regulated prices. An increase in revenue for the hospitals of only 2.32 percent is planned for 2022. Inflation, however, is already at just under eight per cent and will rise to ten per cent. In addition, there are problems that have been known for years, such as the chronic shortage of staff and the failure of the Länder to finance investment costs. It is completely unacceptable that politicians simply accept that 60 percent of hospitals are already in the red this year and that the situation will worsen in the coming year. According to a recent survey by the German Hospital Institute, almost 40 per cent of hospitals see their economic situation as so endangered that insolvencies are imminent. Economically sound financial planning is currently impossible, and in many places hospitals are therefore threatened with closure – with negative consequences for the security of care. For many districts, this could mean that they would have to take over the guarantee mandate in order to guarantee insolvent hospitals. To draw attention to these dramatic economic threats to the hospital landscape, the German Hospital Federation (DKG) launched a nationwide campaign on 5 September. With an info-mobile and other events, the DKG, together with all state hospital associations in all federal states, is calling for immediate inflation compensation for hospitals to prevent uncontrolled insolvencies. On the one hand, we want to inform the citizens, and on the other hand, we want to remind politicians of their responsibility. They must finally take note of the problems of the hospitals and act. We also want to achieve this with our online petition. Further information on the campaign and the online petition can be found at www.dkgev.de on the website of the German Hospital Federation.

What do you expect from the Ministry of Health and the federal states?

The DKG is calling for inflation compensation in order to be able to offset the sharp rise in hospital expenditure. According to a recent survey by the German Hospital Institute, 96 percent of hospitals can no longer pay the increased costs from current revenues. The increases in energy costs alone are bringing hospitals to the brink of insolvency. According to current calculations, a medium-sized hospital will pay more than 6 million euros more for gas and electricity in 2023 than in 2021. Additional expenses in the millions that are not covered. Extrapolated to all hospitals, this alone amounts to a shortfall of around 4 billion euros. Overall, we are assuming a shortfall of 10 billion for 2023. In the past crises, the federal government has demonstrated very impressively that short-term financial aid for companies is also possible on such a scale. Now it is time to do the same for social welfare institutions. Without inflation compensation to stabilise hospitals, there is a threat of massive staff cuts with negative consequences for patient care. The implementation of inflation compensation would simply be possible in the form of a surcharge on hospital bills. This would be a quick, unbureaucratic help. However, the costs must not end up with the health insurance funds, but must be taken over by the federal government in the form of a higher subsidy for the health insurance funds. We need short-term financial help now, and sensible structural and financing reforms in the long term. If the health minister does not help now, the current structural change with its hospital closures will continue to worsen dramatically. Then he will endanger the health care of the population. And the federal states must also finally make their contribution. In the long term, they must finally fulfil their legal obligation to provide sufficient funding for hospital investment costs. For decades, they have borne only a fraction of the costs. In the worst case, hospitals will have no choice but to cut staff in order to avoid the threat of closure. The sufferers of this policy are the patients.

What is the current situation for the sick and the population?

Normally, hospitals have somewhat fewer patients during the summer and holiday season. This year the situation was and is different: treatments that had to be postponed in spring because of the pandemic have to be made up. At the same time, we had a lot of staff absences, so that the staff present were and are under extremely high work pressure. In addition, the emergency departments are also very busy. The fact that all Corona aid for the clinics also ended in the summer makes the situation even more difficult. We will feel this especially in autumn and winter, when more Corona patients have to be treated in the clinics again. Due to the additional workload for the patients, we will be able to treat significantly fewer patients overall. And in this situation we are still struggling with an extremely tight staffing situation in the clinics. Current figures show that staff shortages are endangering the care situation. Currently, 87 percent of hospitals cannot rule out having to close wards temporarily. And almost 80 percent assume that they will have to postpone or cancel scheduled operations and procedures in the autumn due to staff shortages. And in this situation, high staffing targets exacerbate the staff shortage, and the remaining staff are overburdened with extreme bureaucracy. We need a liberating blow. For one thing, we must finally de-bureaucratise and end the culture of mistrust. Hospital workers must be freed from bureaucracy instead of being confronted with more and more demands. The fact that nurses and doctors have to spend three hours a day on often unnecessary documentation work is unacceptable. On the other hand, we need a major digitalisation push to relieve our staff. But we also need to move away from ever smaller staffing specifications. The teams in the hospitals that provide patient care every day need trust and room to work, in order to be able to use their colleagues optimally and for the benefit of care and patients.