Fewer hospitals, better healthcare

style="float: right; margin-bottom: 10px; font-weight: 600;"Sat 20th Jul, 2019

A study by the Bertelsmann Foundation comes to the conclusion that a reorganization of the hospital landscape in Germany is required to enable better hospital care - which can only be achieved by reducing the number of clinics, even if this initially sounds like a contradiction in itself.

In summary, the study comes to the following conclusions:


o Overcapacity exacerbates shortage of skilled workers: there is not enoughm medicalstaff to maintain the current number of hospitals

o Many hospitals are poorly equipped: almost two-thirds of all clinicsh have no coronary angiography, one third does not have computed tomography

o Priority for quality: only clinics with larger specialist departments and more patients have enough practical knowledge to ensure safe treatment

o Concentration and specialization: a qualitatively good supply in Germany is only possible with less than 600 hospitals

o Chance for metropolises: in the greater area of Cologne and Leverkusen 14 instead of 38 acute care clinics would offer sufficient supply while at the same time the distance for patients to get to the hospitals would hardly extend

o Clinics are only one option: especially in rural areas, new shuttle services need to be created and outpatient and semi-stationary solutions need to be established


The number of patients treated stationary in hospital in Germany is higher than almost anywhere else in the world. In 2017 just under 19.5 million cases have been treated in German clinics. There are also 65 percent more patient beds per inhabitant in Germany compared to all other EU countries and patients stay in hospital much longer: the number of so-called bed days per inhabitant is around 70 percent above the average of comparable EU countries.

The problems have been known for a long time: there are too many and often too small hospitals in Germany. The consequence of this insufficient concentration and specialization are deficits in treatment quality and patient safety. In addition, there are overcapacities and business constraints, with the result that a lot of patients are hospitalized who would not need to be treated stationary.

Clinic closures are often perceived as a loss in the opinion of the population. Most discussions are only about accessibility. Questions like the quality of a hospital and patient safety go to the background. Also in the planning of hospitals by the German federal states the aspect "quality" so far is of no great importance.

To find out what needs to be changed in order to receive better hospital care, the Bertelsmann foundation first of all gathered together eight of the most renowned German hospital experts to discuss how the German hospital landscape ideally should look like in 2030. Above all, they considered the quality of supply, but also the accessibility and economy.

In a second study, the IGES Institute Berlin examined in a simulation whether a quality-oriented conversion according to the objectives and criteria of these experts would be feasible, using a region in North Rhine-Westphalia (which contains Cologne, Leverkusen and three surrounding, structurally weaker districts) as an example.

As the simulation showed, the region could offer better care with 14 instead of the current 38 acute hospitals, without patients having much longer travelling times to get there. The pooling of medical staff and equipment would contribute to a higher quality of care in the remaining clinics, especially in emergency care and predictable operations. Only these clinics in the region have the technical equipment to adequately treat heart attack patients.

Looking abroad shows that the potential for a reduction in the number of hospitals is given. By international standards, Germany on average has more medical staff per capita than comparable countries, but less per patient. This paradoxical situation is due to the fact that in Germany a lot more patients are treated in hospitals compared to other countries. Research has shown that around a quarter of cases currently treated in German hospitals do not require inpatient care.

Although the concrete design of the outpatient structures has still to be developed, the results of the study nevertheless prove that there is no alternative to concentration in the hospital sector. On the one hand, an increase in quality can only succeed if both the patients and the medical and nursing professionals are brought together in larger, more specialized clinics. On the other hand, well-trained staff will be scarce in the future and hospitals will only be able to guarantee appropriate specialist and nursing expertise at all times by bundling.


More information can be found here: https://www.bertelsmann-stiftung.de/en/publications/publication/did/spotlight-gesundheit-neuordnung-der-krankenhaus-landschaft/

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