There are around 1,700 hospitals in Germany, from university clinics to district hospitals. The care costs around 127 billion euros a year, with the statutory health insurance companies contributing 86 billion euros alone. The rest is divided between private and other social insurances and public budgets.

There is a lot of surgery and inpatient treatment here. The Bielefeld health economist Wolfgang Greiner summarizes the situation as follows: “We do not have too few nurses or doctors. But we treat too many people in hospitals instead of outpatients. That is expensive and puts a strain on both employees and patients.”

With the corona pandemic, the number of patients has probably fallen permanently, and in particular the number of operations that can be performed has decreased. The lower utilization, but also high energy prices and inflation are affecting the houses. Many have economic problems or slide into bankruptcy . Supply is becoming scarce in rural areas, while smaller hospitals often compete for “customers” in cities. Other countries have already rebuilt their clinics and rely on larger units and specialization of individual centers.

Now Federal Health Minister Karl Lauterbach (SPD) wants to rebuild the clinics , close small houses and set up outpatient health centers in the country. Payment should no longer only be based on the number of cases treated, but also on what a hospital offers. All of this will provoke resistance, but could also bring better results for employees and patients alike. Outpatient instead of inpatient treatment costs could drop, but initially it will probably take high investments for a conversion.