Grants to clinics: where are the additional intensive care beds?

In 2020 there was a lot of money from the health insurances for new intensive care beds. Some clinics built astonishing capacities in the process. But many beds are available according to research by WDR, NDR and SZ in the warehouse. And there is a lack of nursing staff.

Probably no other country in the world had as many intensive care beds as in Germany before the outbreak of the corona pandemic. According to statistics from the OECD, the average in industrialized countries was twelve intensive care beds per 100,000 inhabitants. In Canada there were 13, in France 16, in the USA 17, but in Germany 34 hospital beds for the critically ill.

Nevertheless, in March 2020, in view of the corona pandemic, the German Ministry of Health asked hospitals to increase this high number. A funding program was therefore announced that promised each clinic 50,000 euros per new intensive care bed.

For this purpose, 686 million euros were transferred to the clinics last year, so mathematically there should be around 13,700 new intensive care beds – in addition to the 28,0000 beds already available at the time. But even for the Federal Audit Office in its most recent report at the beginning of June it was not understandable where these beds were. He criticized Health Minister Jens Spahn for the fact that his house “has not yet been able to reliably determine the number of intensive care beds actually set up or additionally purchased”.

Have clinics used the money correctly?

That should now be the end of it: The Federal Ministry of Health (BMG) has one that has not yet been noticed by the public Excel table published on its website, from which you can read how high the cash flows to each individual hospital in Germany for the construction of new intensive care beds were.

The ministry itself now seems to have doubts as to whether everything was always right when setting up the intensive care beds – or whether there were clinics that simply made money in this way for beds that were actually not newly created.

A letter from BMG State Secretary Thomas Steffen to the federal states on June 21, the WDR, NDR and “Süddeutscher Zeitung” (SZ) is available, expresses mistrust. In it, he 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”. Above all, the ministry is also 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”.

Only statutory health insurances paid

The topic is causing a lot of trouble right now. Above all, the statutory health insurance funds (GKV) are pushing for an examination of the new intensive care beds that have been purchased because they had to pay for most of the construction from their funds through the health fund. The private health insurances contributed nothing.

“Subsequent participation by private health insurers in the financing is not planned,” said BMG spokesman Hanno Kautz on request. At a meeting of the board of directors of the National Association of Statutory Health Insurance Funds, representatives are even said to have brought a criminal investigation into play. 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.

Different levels of funding in the countries

An analysis of the payments to the hospitals shows that the clinics in the individual federal states have received very different amounts of funding. While in Bavaria only two new intensive care beds were financed per 100,000 inhabitants, there were 18 in Baden-Württemberg, 19 in Lower Saxony and 31 in Saarland.

More than 800 clinics in Germany have received money to build new intensive care beds, including small specialist clinics for orthopedics, neurology and some rehabilitation clinics. The Stuttgart Clinic and the Schleswig-Holstein University Clinic (UKSH) received the most grants nationwide, each receiving 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 remaining 166 beds are to be understood as “reserve”. However, one is able to “operate the high number within a few days if necessary”.

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, should be understood as a “buffer”, “the devices are in the emergency camps,” as the clinic’s spokesman announced. However, a clear emergency level concept has been developed, employees have been trained and an additional gas store has been set up so that these beds can be put into operation quickly if necessary.

“Emergency reserve” instead of ready-to-use beds

Whoever you ask of the top 10 payees, you can hear everywhere that the majority of the newly financed intensive care beds are not immediately ready for use, but are understood as a reserve. Apparently they were aware of that.

Already in Spahn’s law, setting up an intensive care bed was enough to receive the grant of 50,000 euros. His spokesman Kautz emphasizes: “The prerequisite for the funding was not that these beds were 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 Stefan Zorn 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 disaster,” writes Zorn via email.

Definition is missing

“Above all, one should have defined what an intensive care bed is,” criticizes Wulf-Dietrich Leber from the umbrella association of statutory health insurance companies. Because only in this way could one also observe “whether additional beds have been built, a nationwide definition has not yet been established”.

So there remains the question of the Federal Audit Office, for example, whether there were takeaway effects with this funding at 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 state.

The health insurances in turn finance the operation through flat-rate illnesses, so-called 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 were able to save on their investments.

By the way: while Germany financed around 13,700 new intensive care beds last year, there are fewer than 5,000 such beds in 43 countries on the African continent.