In probably no other country in the world were there as many intensive care beds as in Germany before the start of the corona pandemic. According to statistics from the Organization for Economic Cooperation and Development (OECD), there are an average of twelve intensive care beds for every 100,000 inhabitants in industrialized countries. In Canada there are 13, in France 16, in the USA 17 and in Germany 34 hospital beds for the seriously ill. But in the face of the pandemic, that didn’t seem enough to the Federal Ministry of Health (BMG) in Berlin.
In March 2020, when the Covid 19 patients in Bergamo could no longer be cared for and the coffins were piled up, Germany’s hospitals were motivated with a funding program to increase the high number of intensive care beds. 50,000 euros per new intensive care bed was a temptation for clinics, which many were only too happy to give in.
Last year, a total of 686 million euros were transferred to the clinics for new intensive care beds. In view of the 50,000 euros per bed, 13,700 new intensive care beds should have come out – in addition to the 28,000 already existing ones. But where are these beds actually located? According to its latest report from the beginning of June, this was not understandable even for the Federal Audit Office. He criticized Health Minister Jens Spahn (CDU) for the fact that his house “has not yet been able to reliably determine the number of intensive care beds actually set up and the number of additionally purchased intensive care beds”.
The ministry has apparently taken that to heart. So far, unnoticed by the public, the BMG published a table on his website, from which it can be seen how high the cash flows to each individual hospital in Germany for the construction of new intensive care beds. Because the ministry itself now seems to have doubts as to whether everything went right with the construction of the intensive care beds – or whether there were clinics that simply made a lot of money this way for beds that were actually not newly created.
The State Secretary now wants “concrete evidence”
A letter from BMG State Secretary Thomas Steffen dated June 21st to the federal states, the NDR, WDR and Süddeutscher Zeitung is present, expresses the displeasure. In it, Steffen asks the federal states, with a deadline of July 15, “to request specific evidence from the hospitals in the form of invoices, cost statements and the like for the purchase of new intensive care beds”. The ministry is particularly interested in “whether and in which cases the procurement of new intensive care beds or the conversion of existing beds into intensive care beds could not be proven by the hospitals” and therefore “funds paid out have been reclaimed due to a lack of evidence”.
The topic is causing a lot of trouble right now. Above all, the statutory health insurance funds (GKV) are pushing for the allegedly purchased new intensive care beds to be checked because they had to pay for most of the construction from their own funds through the health fund. The private health insurances contributed nothing. “Subsequent participation by private health insurance in the financing is not planned,” a BMG spokesman said on request. At a meeting of the board of directors of the National Association of Statutory Health Insurance Funds, representatives even called for the proceedings to be clarified under criminal law.
Statutory health insurance vice boss Stefanie Stoff-Ahnis said that the provisions for the construction of the beds were too vague, as the association confirmed on request. “Above all, you should have defined what an intensive care bed is so that you can also see whether additional beds have been set up,” says Wulf-Dietrich Leber, head of the hospitals department at the National Association of Statutory Health Insurance Funds. “So far there has been no national definition.” This was only created with the Divi intensive care bed register.
An analysis of the payments to the hospitals shows that the clinics in the individual federal states have used the funding pot in very different ways. While Bavaria only financed two new intensive care beds per 100,000 inhabitants, there were 18 in Baden-Württemberg, 19 in Lower Saxony and even 31 in Saarland. Neurology and some rehab clinics.
The Stuttgart Clinic and the Schleswig-Holstein University Clinic (UKSH) received the most grants nationwide, each of which received 11.7 million euros for the construction of 234 intensive care beds. In fact, there were 172 intensive care beds at the UKSH before the pandemic, and 240 beds are currently in operation, according to the clinic. The missing 166 beds are to be understood as “reserve”. However, one is able to “operate the high number within a few days if necessary”.
209 beds as “buffer”
Before the pandemic, the Stuttgart Clinic had 90 intensive care beds; at the end of last year there were 115. The 209 intensive care beds, which are missing compared to the funding amount, are to be understood as a “buffer”, “the devices are in the emergency camps,” as the clinic’s spokesman said.
Whoever you ask of the top 10 payees, you can hear everywhere that the newly financed intensive care beds are for the most part not operational, but are understood as a reserve. Even in Jens Spahn’s law, setting up an intensive care bed was enough to receive a grant of 50,000 euros. His spokesman emphasizes: “The prerequisite for the funding was not that these beds were also kept in permanent operational readiness.” This is why these new beds can usually only be found in the Divi intensive care register as an “emergency reserve” or “as a reserve outside the time horizon of seven days”.
The Hannover Medical School also provides a reason. Its spokesman explains: “It was clear to everyone that these intensive care beds would not simply be equipped with nursing staff.” If the corona situation had gotten dramatically worse, nursing staff from non-intensive care areas, operating theater staff and medical students would have been trained and deployed accordingly. “We are aware that we cannot meet the quality requirements that we would have placed on our staff under normal conditions, but this would have been a measure to avert a catastrophe,” the spokesman wrote by email.
Nevertheless, the question of the Federal Court of Auditors remains, for example, whether there were deadweight effects with this funding in some clinics. The federal states, which are now being requested by the BMG to carry out checks, should not have any interest in this. Because in principle it is the case that the federal states have to finance the equipment of the clinics in their country, the health insurances in turn finance the operation through flat-rate illnesses (DRGs). In 2020, however, the federal states were in the fortunate position that the federal government suddenly obliged the statutory health insurance companies to finance the provision of intensive care beds. Every bed, every ventilator and every EKG that was purchased or even just replaced during this time, the federal states save on their investments.