Pati­ent mobi­lity in Ger­many — and why there is still a lot to do

Almost half of Ger­man citi­zens con­sider the health­care sys­tem in Ger­many to be over­bur­dened. Nur­sing staff and doc­tors in hos­pi­tals are par­ti­cu­larly affec­ted by the pan­de­mic. Medi­cal prac­ti­ces are also strugg­ling with addi­tio­nal pro­blems. The atten­tion they deserve is gro­wing to a new level. But that is not enough.

Care is not only negle­c­ted during excep­tio­nal times, there is also a lot of poten­tial for impro­ve­ment in “nor­mal” day-to-day busi­ness. For­mer Fede­ral Minis­ter of Health Jens Spahn has also reco­gni­zed the importance of well-equip­ped and func­tio­ning hos­pi­tals and has pro­mi­sed them sup­port on this long and dif­fi­cult road. A new Hos­pi­tal Future Act is inten­ded to help and make the health­care sec­tor more digi­tal. The fede­ral govern­ment is dili­gently pro­vi­ding funds for this. A total of 3 bil­lion euros is to flow into this alone. A fur­ther 1.2 bil­lion will be pro­vi­ded by the fede­ral sta­tes. The pro­blem is huge. Hos­pi­tals, the cor­ner­sto­nes of health­care in all health­care sys­tems, are strugg­ling with a variety of chal­lenges. There is also great need and poten­tial for impro­ve­ment in doc­tors’ sur­ge­ries. Let’s take a look at the chal­lenges of pati­ent transportation.

Ger­many is a pio­neer in many areas in the Euro­pean Union. This includes the num­ber of pati­ent move­ments, i.e. the num­ber of peo­ple who have to enter and leave hos­pi­tal. Around 24,400 out of every 100,000 inha­bi­tants have to be dischar­ged from hos­pi­tals every year. All these peo­ple have to get to the hos­pi­tal and then be brought back to their own homes. Dr. Wib­be­ling from the Fraun­ho­fer Insti­tute descri­bes a func­tio­ning hos­pi­tal infra­struc­ture as an essen­tial fac­tor. This is not sur­pri­sing. There are also the trips to doc­tors’ sur­ge­ries for out­pa­ti­ent tre­at­ment. In 2020, this resul­ted in the incre­di­ble figure of over 50 mil­lion ambu­lance jour­neys and pati­ent trans­ports. When you hear these words, you might auto­ma­ti­cally think of the bright blue lights and wai­ling sirens of an ambu­lance, or the bla­ring rotors of a res­cue heli­c­op­ter. But far from it. More than 37 mil­lion jour­neys of this kind were made by cab or ren­tal car. This also includes trips to exami­na­ti­ons such as X‑rays or dia­ly­sis. This type of pati­ent trans­por­ta­tion thus wins the gold medal by a wide mar­gin. Far behind in second place are pati­ent trans­ports with just under 5.4 mil­lion jour­neys. These are the actual jour­neys to hos­pi­tals. In other words, around 566 every day in Ger­many alone. This means at least 566 stressful, important phone calls every day, and that’s just with pati­ents. Added to this is the effort invol­ved in the com­plex and time-con­sum­ing orga­niza­tion of boo­king and coor­di­na­tion with trans­port ser­vices. It is not sur­pri­sing that this often results in hours of wai­ting time for patients.

One fac­tor that also plays into the com­ple­xity of pati­ent trans­por­ta­tion boo­kings at hos­pi­tals is the change in the hos­pi­tal land­scape over the past decade. Ger­many has expe­ri­en­ced a signi­fi­cant reduc­tion in the num­ber of hos­pi­tal beds on offer. The length of stay per tre­at­ment case has also decreased. Bet­ween 1991 and 2019, the num­ber of beds fell from a good 665,000 to just 495,000. The average length of stay fell by almost half (from 14.0 to 7.2 days per pati­ent). These figu­res are worry­ing in many respects in the con­text of pati­ent trans­por­ta­tion. Fewer beds means more effort to find the right hos­pi­tal with the right depart­ment for pati­ents. If a hos­pi­tal is full, the next one has to be cont­ac­ted. This deve­lo­p­ment is par­ti­cu­larly acute in con­nec­tion with the num­ber of tre­at­ment cases. This rose by almost 5 mil­lion in the period descri­bed, from 14.6 to 19.4 mil­lion peo­ple. The requi­red speed and respon­si­ve­ness of the orga­ni­zers must also be con­stantly remin­ded of the decre­asing length of stay of pati­ents. Shorter lengths of stay mean more demand for trans­por­ta­tion to and from the hos­pi­tal — quickly and fle­xi­bly. Ano­ther deve­lo­p­ment that has not made pati­ents’ jour­neys any shorter is the ste­adily incre­asing pri­va­tiza­tion and pro­fit ori­en­ta­tion of hos­pi­tals. In 1992, only 14.8 per­cent of all hos­pi­tals in Ger­many were in the hands of pri­vate owners. Just 27 years later, this figure had risen to 37.8 per­cent. Pro­fit ori­en­ta­tion is firmly ancho­red in our society. We all pro­fit and lose from it to some ext­ent. For hos­pi­tal staff and con­trol cen­ters, howe­ver, this can be a night­mare, espe­ci­ally in terms of pati­ent trans­por­ta­tion. Due to the pro­fit ori­en­ta­tion, less pro­fi­ta­ble depart­ments in hos­pi­tals are incre­asingly being clo­sed. One can observe a spe­cia­liza­tion in tre­at­ment areas in the hos­pi­tal land­scape. This may have some advan­ta­ges, but it also means that the distances and thus the jour­ney for pati­ents are often lon­ger. If an ortho­pae­dics cli­nic clo­ses, you just have to go to the next one. No mat­ter how far away.

In the ran­king of the best health­care sys­tems world­wide, Ger­many is in second place. The pro­blems descri­bed are the­r­e­fore not “show stop­pers”. Rather, inno­va­tive and tar­ge­ted solu­ti­ons are nee­ded that help peo­ple, whe­ther pati­ents, hos­pi­tal staff, care pro­vi­ders or trans­port staff, to over­come these hurd­les. With the inte­gra­tion of such solu­ti­ons, this can be achie­ved. Capa­ci­ties and bud­gets have been crea­ted. Ger­many as a coun­try of inno­va­tion has the oppor­tu­nity to initiate decisive pro­ces­ses. Accor­ding to the “Bloom­berg Inno­va­tion Index 2020”, which is based on the seven equally weigh­ted cate­go­ries of R&D inten­sity (rese­arch & deve­lo­p­ment expen­dit­ure), manu­fac­tu­ring value-added, pro­duc­ti­vity, high-tech den­sity, ter­tiary effi­ci­ency, rese­ar­cher con­cen­tra­tion and patent acti­vity, Ger­many is the most inno­va­tive coun­try in the world. It can the­r­e­fore be up to start-ups to create sui­ta­ble solu­ti­ons for com­plex pro­blems. The infra­struc­ture for this is in place. Inci­den­tally, Japan takes first place in the health­care sys­tems ran­king. A coun­try that is famous for its tech­no­lo­gi­cal sophisti­ca­tion and also for its start-up landscape.