How many clinics does the country need?

Status: 11.01.2022 1:12 p.m.

A short walk to the hospital can save lives. So should the small and often deficit clinics in rural regions be preserved? Or do you need fewer, but large, specialized houses?

The municipality of Kloster Lehnin is located almost on the western border of Brandenburg. Around 10,000 people live here. There are schools, daycare centers, libraries and there was also a hospital until the turn of the year 2020/21. With “Internal Medicine” it had only one specialist department and with 55 beds it was the smallest clinic in Brandenburg.

The clinic has been making losses for years: among other things, “the hospital has a very limited catchment area with around 10,000 inhabitants that does not allow the high maintenance costs to be refinanced,” according to a press release that the operator published at the end of 2019 and thus also had announced the end. The house wants to increase the rehab department instead.

The Lehnin Hospital is one of 20 that was partially or completely closed or relocated in 2020. According to the Federal Statistical Office, the Total number of beds decreased by 1.5 percent in 2020.

More than 30 minutes to the nearest clinic

“The result is that in certain regions, the distances people are traveling to the nearest hospital are increasing,” says Klaus Emmerich. He headed two municipal hospitals in Bavaria for almost 18 years. In his experience, the effects of clinic closings are particularly great for people in rural areas. “We now have 115 postcode regions in Bavaria where the distance to the hospital is more than 30 minutes.” And that could make the difference between life and death, he says. For example, if a patient is about to bleed to death after a traffic accident.

Emmerich is part of the “Alliance Clinic Rescue”, whose most important requirement is the preservation of all hospitals. The state should financially absorb deficit houses. And these are especially the small ones: “Every hospital has certain costs for its medical-technical equipment, for example X-ray machines. Large hospitals can distribute this to 500 or 1,000 beds, small hospitals only to 200 or 100 beds.”

In addition, large, specialized hospitals could earn a lot more money: After all, specialized interventions are more lucrative than general treatments.

More centralization?

In order to join forces and guarantee high-quality treatments, health economists repeatedly advocate centralizing the hospital landscape in Germany – i.e. closing small clinics to strengthen the large specialists.

This is aimed primarily at the federal states that are responsible for planning requirements in this area. A 2019 study by the Bertelsmann Foundation recommends that most of the hospitals should be closed. The study comes up with a harsh verdict, especially on small hospitals: “The hospital landscape is characterized by overcapacity and insufficient specialization. Current care is not only bloated and expensive; patients are also being cared for much worse than necessary.” Instead of almost 1,400 clinics in Germany, only 600 would be required.

60.2 beds per 10,000 inhabitants

In fact, there are comparatively many hospital beds in Germany: there are 60.2 hospital beds for every 10,000 inhabitants. According to Eurostat, the EU average is 39.3.

Ex-Health Minister Jens Spahn summed up the problem last summer as follows: “We have oversupply, especially in the metropolitan area. And we also have some undersupply. But we have structures that meet needs in too few places.”

Spahn’s successor in the health department had already spoken out in favor of restructuring the German hospital landscape in 2019. Karl Lauterbach wrote on Twitter: “Everyone knows that we should close at least every third, actually every second, clinic in Germany. Then we would have enough staff in other clinics, lower costs, better quality, and not so much superfluous. Countries and cities To block.”

The hospital in Kloster Lehnin has now been closed for a year. The Brandenburg state government does not see this as jeopardizing the medical care of the population. “The next acute inpatient offers for all important disciplines with emergency care are in Brandenburg / Havel (29 minutes), Potsdam (37 minutes), Ludwigsfelde (30 minutes) and Treuenbrietzen (33 minutes).” The supply close to home is thus secured.

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