GERMANY
Mr George Baum
HOPE Governor, German Hospital Federation
Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
In the last 5 years, political priorities have
focussed on the continuous development of
quality assurance and of the reimbursement
systems for healthcare providers. Additionally,
a great importance has been given to measures to
face the challenge of health workforce shortage.
In 2015, the so-called Hospital Structures Act
(Krankenhausstruktur-Gesetz) enforced quality
assurance in hospitals; improved financing of
nurses and strengthened patient safety as regard
nosocomial infections by fostering a hygiene
support programme. This act entered into force
on 1 January 2016 and included the following key
aspects:
• Establishing a job promotion programme for
nurses for the years 2016–2018 with a total
volume of 660 million Euros;
• Transforming a former extra-fee to safeguard
structures for healthcare provision
(Versorgungszuschlag) into an extra-fee for care
(Pflegezuschlag) with an overall volume of 500
million Euros;
• Introducing binding quality indicators for
hospital planning;
• Developing further initiatives on quality such as
patient friendly quality reports, quality contracts
as well as quality-associated extra-fees and
deductions;
• Establishing funds for the improvement of
healthcare-structures with a volume of 500
million Euros;
• Definition of minimum standards for hospitals
for the provision of emergency care.
The training of nurses has been subject of
reform with the 2015 Nursing Professions Reform
Act (Pflegeberufereformgesetz). Training for
nurses, paediatric nurses and long-term care
nurses have been merged into a unique
programme.
With a law on the continuous development of
provision and reimbursement of psychiatric and
psychosomatic care in the year 2016, a services-
oriented financing for hospitals has been
introduced. Transparency has been enhanced and
a better coordination of inpatient and ambulant
services enabled.
In May 2018 the most important hospital act
in the running legislative period for hospitals has
been forecasted. With the Care Personnel
Strengthening Act
(Pflegepersonalstärkungsgesetz), the general
status of nursing and long-term care shall be
improved. It is focussed on the full
reimbursement of labour costs for care personnel
and its extraction of the DRG-system starting with
the year 2020. Additionally, partners of the
self-governance system (health insurances and
services providers) have been mandated to extend
the already existing minimum levels for care
personnel to further departments in the hospitals.
This law came into force at 1 January 2019.
GERMANY
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
18
HHE 2019 | hospitalhealthcare.com
2002 2008 2016
10.1%
10.2%
11.1%
77.8%
75.3%
84.6%
29.6%
28.8%
29.1%
12.4%
14.0%
12.4%
887.0
821.0
806.0
663.0
613.0
606.0
20.2
21.2
23.7
9.6
8.3
7.5
332.0
354.0
419.0
1018.0
1113.0
1285.0