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

Overwork, excessive demands, pressure and staff shortages. You read and hear these buzzwords again and again these days in the context of the healthcare sector.

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.

The initial situation

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.

What hap­pens next?

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.

You can also fol­low us on LinkedIn!

Kon­stan­tin Leidinger