Hospitals in Germany - data & facts

Ingrid Müller is a chemist and medical journalist. She was editor-in-chief of for twelve years. Since March 2014 she has been working as a freelance journalist and author for, among others, Focus Gesundheit, the health portal ellviva.de, the publishing house living crossmedia and the health channel of rtv.de.

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In 2017 there were 1,942 hospitals in Germany. This number has been falling for a number of years. In 1998 there were 2,263 clinics, in 2009 still 2,080 and in 2011 still 2,045 clinics. The number of hospital beds and bed occupancy also decreased. In total, clinics provided exactly 501,475 beds in 2016 - that was over 2,500 beds less than in 2012. The number of preventive or rehabilitation facilities in 2016 was 1,149.

Compared to before, patients spend fewer days in the clinic. The length of stay fell from ten to 7.3 days on average. The reason: hospitals are no longer paid according to the length of stay of their patients, but according to fixed flat rates (DRGs).

In contrast, the number of stays is increasing: In 2012, the hospitals in Germany provided inpatient care to 18.6 million people. In 2017 there were already 19.4 million.

Hospital - the definition

The legislator understands a hospital as any facility in which illnesses, ailments or physical injuries are to be diagnosed, cured and / or alleviated through medical and nursing services, obstetrics are provided and in which the patients or persons to be cared for can be accommodated and cared for. Hospitals must be under constant medical supervision, have sufficient diagnostic and therapeutic options, and work according to scientifically recognized methods.

Trend towards privatization

The structure of the clinic landscape is changing: More and more clinics are being privatized and are becoming private sponsors. In return, the proportion of public and non-profit (e.g. church) sponsorships is falling. In 2011, 30.4 percent of the clinics were public, 36.5 percent non-profit and 33.4 percent private.

Since clinics with public providers (currently 30 percent) are often particularly large, this is where most of the beds are (47.8 percent). Here, too, there is a trend towards privatization, and the proportion of beds in private houses (currently over 30 percent) is steadily increasing. The share of beds in non-profit establishments, on the other hand, is falling (from 34.1 percent in 2012 to 18.7 percent in 2017).

Full and part inpatient hospital services of the clinics that are included in the hospital requirement plan of the respective federal state are remunerated in accordance with the Federal Care Rate Ordinance or the Hospital Remuneration Act. All public and non-profit hospitals must bill according to these guidelines. In the private clinics, on the other hand, there are also houses that are not subject to the statutory provisions and can therefore set their prices freely. This can lead to difficulties with the reimbursement of hospital services by health insurance.

Inpatient versus outpatient

Traditional hospitalization is inpatient. This means that a patient spends several days in the clinic. However, clinics also have outpatient departments in which examinations or treatments are carried out that are sometimes not possible in a doctor's office. The patient can then go home again (on the same day). There are also special consultation hours and outpatient clinics, for example for diabetics, tinnitus patients or allergy sufferers.

The strict separation between outpatient doctors and clinics of all kinds is to be softened in the future. "Integrated care", which was introduced as part of the 2000 health reform, relies on comprehensive forms of care. It promotes greater networking between the various specialist disciplines and sectors (general practitioners, specialists, hospitals). The aim is to improve the quality of care for patients and reduce health expenditure.

Types of hospitals

There are different types of hospitals in Germany. A distinction is made between university clinics, general hospitals, specialist hospitals, affiliated hospitals, practice clinics and day and night clinics.

University hospitals are to provide comprehensive inpatient care for the population. Another focus is medical education and research.
General clinics should provide comprehensive inpatient care to the population. There are several medical specialties here.
Specialist clinics specialize in certain areas (e.g. endocrinology, dermatology, ophthalmology).
In affiliated hospitals, medical services are not provided by employed doctors, but by registered contract doctors. The hospital only provides the premises, provides accommodation, food and care for the patients.
A practice clinic is a company that mostly resident doctors run. As a rule, outpatient therapies (including operations) are carried out here. The patient can stay there overnight (usually only one).
A day clinic is an outpatient / semi-inpatient care facility. Patients can be treated or cared for here for up to 24 hours. There are more and more operative day clinics at hospitals - outpatient operations are carried out here.

In principle, a patient is free to choose the hospital. However, not all treatments are offered in every clinic. A look at the clinic's quality report can be helpful here: clinics have been legally obliged to provide information about their structures and services since 2005.

Depending on their care task, hospitals are classified into different categories. A distinction is made between hospitals with basic and standard care, regional hospitals with a medium level of care and specialized hospitals (e.g. university hospitals) with maximum care. The clinics are usually divided into departments such as internal medicine, surgery, ENT, dermatology or urology. Most hospitals also have intensive care units.

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