Better patient care by drastically reducing hospitals

Better patient care by drastically reducing hospitals

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Study: More than every second hospital in Germany should close

According to a new study, patients in Germany could receive better care if more than every second hospital closes. According to the authors, the clinics could then be better equipped for life-threatening emergencies.

Fewer and fewer hospitals in Germany

It was reported years ago that more and more clinics are at risk of bankruptcy or have had to close. As a result, more and more patients are treated in fewer and fewer hospitals. And this development may continue - but according to a new study, this would have advantages for the patients. Because the medical care would improve through the closure of hospitals.

Halve the number of clinics

According to a study commissioned by the Bertelsmann Stiftung, there are too many hospitals in Germany.

A sharp reduction in the number of clinics would therefore improve the quality of care for patients and alleviate existing bottlenecks among doctors and nursing staff.

"In our new study, leading hospital experts point out that many hospitals in the Federal Republic of Germany are too small and often do not have the necessary equipment and experience to adequately treat life-threatening emergencies such as a heart attack or stroke," says one Message.

According to the experts, many complications and deaths could be avoided by concentrating on well below 600 instead of just under 1,400 clinics today.

"It also went hand in hand with better equipment, greater specialization and better care by specialists and nurses," writes the foundation.

Improved patient safety

In order to arrive at these results, the Berlin Institute for Health and Social Research (IGES) has investigated the question of what care from clinics would look like, which is not primarily based on quick accessibility, but on quality criteria.

These include, for example, secure emergency care, 24/7 specialist readiness, sufficient experience and routine of the medical staff, as well as adequate technical equipment.

"The reorganization of the hospital landscape is a question of patient safety and, above all, must pursue the goal of improving the quality of care," said Brigitte Mohn, Board Member of the Bertelsmann Stiftung.

By contrast, a primary orientation towards travel times would go in the wrong direction, the authors believe.

"If a stroke patient reached the nearest clinic after 30 minutes but could not find a qualified doctor and the medically necessary specialist department there, he would have preferred to be taken to a well-equipped clinic a few minutes longer," says Mohn.

Pooling of medical personnel and equipment

According to the information, the leading German hospital experts developed a target image for Germany as a first step for the study, which is based on the specified quality criteria.

The IGES then calculated in a simulation how mandatory compliance with these requirements would affect the clinical landscape of an entire region.

The choice fell on the greater Cologne / Leverkusen area, which is characterized by both urban and rural areas.

As stated in the communication, the simulation showed that the region could offer better care with 14 instead of the current 38 acute care hospitals without the patient having to put up with much longer travel times on average.

The bundling of medical personnel and equipment would therefore contribute to a higher quality of care in the remaining houses, especially in emergency care and in operations that can be planned.

According to the information, only these clinics in the region have the technical equipment to adequately treat heart attack patients.

"The result that a reduction to less than half of the clinics in the region under consideration would lead to an improvement in care initially sounds drastic," said international hospital expert Uwe Preusker.

But in many places the calculation was based on rather conservative assumptions, for example the amount of medically required services or the length of stay in the hospital.

"Both are significantly lower in comparable countries," said Preusker. According to the expert, if one were to follow the international standard, one would have to initiate a much more consistent restructuring process.

Many patients would not have to be treated in hospital

According to the Bertelsmann Foundation, a look abroad actually shows that there is potential for reducing the number of clinics.

"In an international comparison, Germany has on average more medical staff per inhabitant than comparable countries, but less per patient," the report says.

And further: “This paradoxical situation is due to the fact that many more patients are treated in hospitals in Germany than abroad. According to studies, around a quarter of the cases treated in German clinics today would not have to be treated in hospital. "

The specific design of the surrounding outpatient structures is still open, but the findings of the study prove that there is no alternative to concentration in the hospital sector.

On the one hand, an increase in quality can only succeed if both the patients and the medical and nursing specialists are brought together in larger, specialized hospitals with more cases.

On the other hand, well-trained staff will continue to be scarce in the future. Only through bundling could regular care clinics in all central departments maintain the appropriate specialist and nursing expertise at all times. (ad)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Bertelsmann Foundation: Better care is only possible with half as many clinics, (accessed: July 15, 2019), Bertelsmann Foundation

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