How many hospitals does Germany need?

Which ones can be closed?

These questions have been discussed very emotionally for years.

Compared to other EU countries and measured against the number of inhabitants, Germany has a particularly large number of clinics and beds.

Economists, health insurance companies and federal politicians argue that the system can hardly be financed and that it ties up staff that are urgently needed elsewhere.

Fewer hospitals and more specialization could also increase the quality of care.

Mayors, district administrators and prime ministers counter that people should be able to reach a clinic quickly – even in rural areas.

Britta Beeger

Editor in Business.

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A still unpublished study by the RWI - Leibniz Institute for Economic Research in Essen - now suggests that clinic closures have an impact on patient care, but do not seriously endanger the accessibility of hospitals.

The study is based on 18 hospitals that were closed in Germany between 2015 and 2018.

There were funds for this from the health fund and the federal states via the Hospital Structure Act.

Overcapacity should be reduced and inpatient care streamlined.

"Towards a planned hospital structural reform"

The result: According to the analysis by RWI health economist Anne Mensen, the travel time to the nearest hospital increased for around 700,000 people - but on average only by around seven minutes.

Beyond the average value, of course, there are differences.

Three quarters of the affected population needed less than ten minutes longer by car, but 10 percent still needed more than 20 minutes more.

For 17,500 people, the nearest hospital was now more than 30 minutes away.

The closure of the clinics also led to a drop in the number of hospital stays: by a good 2 and a good 3 percent respectively in the first two years.

This is not a problem per se if the people are treated elsewhere - for example on an outpatient basis, according to the study.

It could even speak for more efficient healthcare.

Mensen cannot answer on the basis of their data whether the people were actually treated on an outpatient basis and to what extent urgent cases were affected.

She refers to another study, according to which less urgent cases are affected by clinic closures, but mortality among patients with time-critical illnesses increased by 5 percent.

Given the shortage of health care workers and the aging population, merging hospitals is in many cases "an important measure to increase efficiency," says Mensen.

The researcher also cites the quality of treatment as an argument.

However, she also concludes from her results: "In order to ensure appropriate care for older and less mobile people as well, hospital closures must be carefully planned and go hand in hand with concepts for expanding outpatient care."

What that can look like in concrete terms is a question that a government commission convened by Federal Health Minister Karl Lauterbach (SPD) is dealing with.

Among the 17 scientists are economists, lawyers and doctors.

They should propose reforms for "modern and needs-based hospital care" and set guidelines for hospital planning, for which the federal states have so far been responsible.

When asked about the proposals, the Federal Ministry of Health did not answer on Wednesday.

The chairman of the board of the German Hospital Society, Gerald Gass, criticized the fact that politicians have so far taken on "no control and no responsibility" for the structural changes.

The results of the study made it clear "that we finally have to move away from the cold structural change towards a planned hospital structural reform," he told the FAZ ."