Hours of waiting, overcrowded corridors, staff shortages: German emergency rooms are at their limit. It has been obvious for years that fundamental reform is needed to relieve the burden on hospitals and provide better care for patients.
The then health ministers Hermann Gröhe and Jens Spahn (both CDU) tried to restructure the system, but both failed to pass a corresponding law. Now Karl Lauterbach (SPD) wants to try. The Federal Health Minister has presented a draft bill that would mean significant changes for patients – and has met with sharp criticism in some quarters.
The plan essentially involves the following: The emergency number 112 is to be merged with 116117, the hotline of the Association of Statutory Health Insurance Physicians, in the background. Both numbers will remain available to patients, but can forward callers to each other. The goal: If a patient calls 112 who is not in a life-threatening emergency, they will be referred directly to the on-call service of the Statutory Health Insurance Physicians – instead of being unnecessarily picked up by an ambulance.
Currently, patients who call 116117 are often stuck in long waiting queues. Therefore, there will be legal requirements for accessibility in the future: 75 percent of callers must be put through within three minutes, 95 percent within ten minutes, around the clock. When the patient is called, there are usually three options: They will speak to a consulting doctor, who can also switch on a video camera if necessary. If further treatment is required, the patient will be visited at home by a doctor or paramedic – or referred to a so-called Integrated Emergency Center (INZ).
The centers are a new construct and are to consist of the emergency room of a hospital and an emergency doctor’s office located right next to the clinic. Depending on the urgency, a decision will be made at a shared counter as to whether the patient will be treated in the emergency room or in the doctor’s office. This procedure also applies to those who turn up at the emergency room unannounced – but with one disadvantage. If the medical treatment is equally urgent, they will be treated lower than those who were previously referred to the emergency room via 116117, according to Lauterbach’s draft.
The main aim of the law is to better control the flow of patients and to only treat those in the emergency room for whom it is actually medically necessary. According to the Ministry of Health, this would save the statutory health insurance system almost one billion euros annually from 2028. Whether this amount is realistic will depend largely on the implementation of the law.
Doctors’ representatives warn that many of the new tasks they are to be given are hardly feasible. This includes, for example, setting up a nationwide round-the-clock transport service in parallel with regular care. “Which colleagues – not to mention the enormous costs – are supposed to handle these services?” says Andreas Gassen, Chairman of the National Association of Statutory Health Insurance Physicians. “We don’t have a reserve of doctors in the fridge.” Added to this is an excess of additional bureaucracy, inadequate and vague refinancing and unrealistic deadlines, says Gassen.
Andrew Ullmann, health policy spokesman for the FDP parliamentary group in the Bundestag, is open to adjustments. “It is very questionable whether there are resources for 24/7 home visits, telemedicine and emergency practices in the evenings. A reform cannot be based on conditions that cannot be met,” Ullmann tells WELT. “That is why we must seek dialogue with the medical profession to evaluate what is affordable and what is not – especially with regard to the upcoming retirements of doctors.”
Janosch Dahmen, health policy spokesman for the Green parliamentary group, rejects the criticism. “The assumption that the same doctor who runs a general practice should now also work in the emergency center or the health control center or make house calls at night is wrong.” Doctors who have agreed to be on call have long been employed full-time or part-time as general practitioners and emergency physicians. “I notice that many younger doctors are very interested in taking on such services in acute and emergency medicine,” says Dahmen.
However, the law needs to be changed in another area: the opening hours of the integrated emergency centers. These are currently: Monday, Tuesday and Thursday from 6 p.m. to 9 p.m., Wednesday and Friday from 2 p.m. to 9 p.m. and on weekends and public holidays from 9 a.m. to 9 p.m. “Nobody can remember these times, we need the same opening hours every day, and as uniformly as possible across the country,” demands Dahmen. In future, neither the type of emergency number nor the time should determine whether the patient receives targeted help.
In addition, it is urgently necessary to include new regulations on the emergency services in the law, said the Green Party member. Lauterbach had originally announced a separate law on the emergency services, but has now apparently abandoned the plan due to time constraints. Instead, the topic is to be included in the emergency reform during the parliamentary process. “The reform of emergency care can only have an impact if we also implement fundamental changes to the emergency services,” warns Dahmen.
Tino Sorge (CDU), health policy spokesman for the Union faction, suspects that the decision not to submit a separate law on the emergency services is a calculation by the health minister: “The plan is to be integrated into the emergency reform through the back door. This is not only legislative chaos that is a foregone conclusion, but a new declaration of war on the states.” The states’ responsibility for the emergency services is anchored in the constitution. If Lauterbach does not develop the reform together with them, there is a risk of another conflict like the one with the hospital reform.
It is noteworthy that in some places, doctors who work in emergency rooms themselves – and whose workload is actually supposed to be relieved by the law – are also skeptical of Lauterbach’s plans. “It is a political misconception that our main problem is the sheer number of mildly ill patients who are within walking distance,” says Matthias Klein, head of the central emergency rooms at the LMU hospital in Munich. Around three quarters of the patients who reach the emergency room on foot have already been in contact with a doctor or come with a referral. Banal complaints that can be identified as such at first glance are rare. “Opening a doctor’s office next to our emergency room would be complex and expensive, but would not significantly relieve our workload,” says Klein.
The core problem lies elsewhere. “The reason why we are overcrowded and have long waiting times is the shortage of resources in the inpatient sector, mostly due to a lack of nursing staff,” says Klein. Seriously ill patients cannot sometimes be transferred quickly from the emergency room to the normal or intensive care unit because all the beds there are occupied. This is also due to other hospitals that are no longer available to transfer emergency cases as they used to be due to a lack of capacity and sometimes close their emergency rooms at night. According to Klein, Lauterbach’s new reform will not change this basic problem.
