Many small hospitals are struggling to survive. But large hospitals also face problems. Two examples from Regensburg show: The situation in the hospital sector is tense before the planned hospital reform.
It sounds dramatic: In the minutes of an internal meeting at the Regensburg University Hospital, the financial situation of the institution is described as worrying: “Since (…) serious deficits are accumulating in the course of the current economic planning for the years 2024 – 2028, urgent action is required. According to these forecasts, this is not the case “The UKR will only file for insolvency due to the guarantee provided by the Free State of Bavaria,” says the minutes of the board and directors’ meeting on November 10, 2023.
The university clinic’s forecast deficit for 2024 is stated to be more than 45 million euros – even though the clinic has even generated slight surpluses in recent years.
Many risks for clinics
When asked, the university hospital put the number mentioned into perspective. The whole thing is a consciously created risk scenario, says the medical director of the UKR, Oliver Kölbl – “a worst-worst scenario”. In it, the clinic calculated how it would be financially in 2024 if several risks came together: continued very high energy costs, lack of refinancing of tariff increases, falling patient numbers and further rising material costs.
Such risk scenarios are quite common. Kölbl explains that there is also a more realistic scenario: it only assumes a comparatively small loss of three million euros. What is astonishing is that this real scenario is not mentioned at all in the minutes of the meeting.
Kölbl admits that the presentation of the risk scenario should once again accelerate the savings efforts in the company. “The aim was of course also to show the employees that efforts are necessary from all professional groups so that this worst-case scenario does not happen, that everyone makes an effort and is motivated and works well together.” The pressure on his management team apparently also had an effect: “The figures for January/February show that everyone got the message because the two months went well,” says Kölbl.
Hospital has already had to close ward
The example shows that the pressure to save money is great even for hospitals that have been in a comparatively good financial position in recent years. This also applies to the Mercy Brothers Hospital in Regensburg. With almost a thousand beds, it is the largest Catholic hospital in Germany.
In recent years, achieving a balanced balance sheet was still quite possible, says managing director Andreas Kestler. But that is becoming increasingly difficult. In 2023, the hospital even had to close the heavily loss-making clinic for geriatric rehabilitation in order to improve the financial situation.
Expenses are rising faster than income
Expenses for hospitals have risen sharply due to price increases and increased personnel expenses as a result of the last collective bargaining agreements. However, the remuneration for services has not grown at the same rate, says Kestler. The scissors are getting further and further apart.
The planned clinic reform, which the managing director is critical of, must improve the financial situation. “I do begrudge our doctors the rate increases of over ten percent in the last two years. But if I only get five percent replaced, it will be difficult at some point, which everyone can imagine,” said the managing director. If that doesn’t change, the clinic will have to think about stopping investments or closing additional areas.
Another point of criticism: the bureaucracy. This is already putting an enormous strain on the clinics. The Hospital Transparency Act, which is on the agenda in the Federal Council this Friday, has no added value for patients and further increases the bureaucratic effort, criticizes the hospital. Managing director Kestler speaks of a “bureaucracy of distrust”.
Economic Position throughout Germany tense
The German Hospital Institute (DKI) regularly surveys hospitals about their economic situation. In the most recent survey, 78 percent of the clinics expected a loss in their balance sheet for 2023. The survey also shows that large hospitals with over 600 beds assess their current economic situation particularly poorly. By 2024, three out of four clinics of this size expect the situation to worsen.
Save money too Personnel key
In order to save money, the Regensburg University Hospital wants to try to further reduce material and energy costs. The medical director Kölbl also admits to cost-cutting measures in terms of staff: last year it was decided to increase the number of patients per nurse. The protocol in question states: “The previous UKR internal convention for defining the care key (…) must be put to the test and should be adapted to the legal regulations.”
Even now we are still a bit above the legal minimum, says Kölbl. In the past, however, they were even more generous and made adjustments here. In the first two months of this year, this cost-cutting measure has already paid off because more cases could be treated, says the medical director.
Criticism of austerity measures
However, union representatives are critical of such savings in care. Heinz Neff from the ver.di trade union in the Upper Palatinate district considers an increase in the number of patients per nurse to be “not responsible”. “We have the legal lower limits, which are an absolute minimum,” says Neff.
Safety is needed for patients and also for staff. “Good care, good medical care also requires appropriately good staffing and cannot be based on any lower limits.” With an additional burden on employees, the workplace becomes less attractive. The problem with large clinics in times of nursing shortages is that they don’t have too many staff, but rather too few.