When small clinics are about to end

Status: 11/13/2021 3:29 a.m.

More and more small hospitals are closing or reducing their offerings. In rural areas in particular, the distances for patients are long. What to do?

Brita Göldner from Hersbruck near Nuremberg almost did not survive. A few months ago, the now 76-year-old suffered a heart attack. She had to be resuscitated five times. But she almost died before that. It took the paramedics half an hour to get to her.

Her husband Walter Hirschmann had to threaten with a complaint, only then did the ambulance service come, the emergency doctor even a little later. “I really thought that was it now,” says Göldner in retrospect. Would the long waiting time have been avoided if the hospital had still existed in Hersbruck? Hard to say.

Specialists are leaving

Some time before Göldner’s heart attack, the clinic was closed, after 112 years. The citizens fought for a long time to preserve it – in vain. The closure of the hospital was like a negative spark. As a result, several specialists, internists and a gynecologist migrated from Hersbruck.

The medical center with outpatient beds for the observation of patients, which is planned by the politicians and which is supposed to compensate for the clinic closure, has not yet been realized. The planned expansion of the nearest hospital in Lauf has not yet started.

The same costs but less income

The problem with small clinics: they have the same costs as the large ones, but they do not treat as many patients and therefore have less income. In addition, the prices for a knee operation or pneumonia are the same everywhere, regardless of whether a clinic is located in a metropolitan area or in the country – thanks to the flat rate system.

According to the “Hospital Rating Report 2021”, 13 percent of hospitals were at risk of bankruptcy in 2019. According to calculations by the German Hospital Association, the clinics received 9.5 billion euros less in 2020. Although there was compensation from the state treasury due to the corona pandemic, it could not compensate for the additional expenditure for infection protection.

Dinkelsbühl is also worried about his hospital

In Dinkelsbühl, a good 100 kilometers from Hersbruck, there is fear that the medical care in the local hospital will deteriorate. Obstetrics has already closed. In 2022, the clinic operator ANregiomed plans to relocate abdominal surgery and parts of trauma surgery to the Rothenburg hospital.

For the patients on site, this means: The ways will be longer, because emergency operations will no longer be possible in Dinkelsbühl. It makes no sense, from a medical or economic point of view, to have fully developed main departments in all hospitals that are manned by specialists around the clock, explains ANregiomed clinic director Gerhard Sontheimer – an attitude that his colleague, ex-clinic manager Klaus Emmerich, does not can understand.

“We cannot do without a hospital bed”

Until his retirement in 2020, Emmerich managed the two hospitals in the Sulzbach-Rosenberg district. In retirement he campaigns against the dying of small clinics in rural areas. “Even due to the pandemic, we cannot do without a hospital bed,” says the spokesman for the nationwide hospital rescue alliance. For him, it’s not about maintaining every single hospital, but about good medical care for everyone.

A 30-minute drive to the hospital

The demand of the alliance: Every citizen must be able to reach a primary care hospital within 30 minutes by car. Basic care, in turn, means that such clinics need at least the departments of internal medicine, surgery, gynecology, obstetrics, intensive medicine and emergency care. If they don’t have it, improvements must be made, says the alliance.

This is to be financed by reducing excess capacities in metropolitan areas. And Emmerich’s greatest wish: the abolition of the flat rate per case. Because, in his opinion, they have brought many small hospitals into the now so difficult situation. But in the exploratory paper of the SPD, Greens and FDP there is nothing about it.


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