Germany´s university hospitals suffer economic crisis
Among Germany´s 2,087 hospitals, the country´s 32 university hospitals, employing 180,000 to care for up to two million patients, may appear to play a marginal role. However, their triad of research, education and applied medicine endow the university hospitals with enormous significance, for they not only represent medical science and research but also educate the nation's future physicians. However, neither their important role, nor their annual income of around Euro13 billion* can conceal the crisis in university hospitals as a whole.
At the annual Hauptstadtkongress in Berlin this May, during a panel discussion headed ‘Crash or altitude flight? University hospitals quo vadis?’ five experts spoke of the current state of their university hospitals and economic strategies.
The cause of the crisis was generally agreed: lasting under-funding/rising costs. Three of the experts – Dr Andreas Tecklenburg, Member of the Board in the department of patient supply and Vice-president of Hannover Medical School; Prof Wolfgang Holzgreve, executive medical director and chairman of the Board at Freiburg University Hospital and Prof Rüdiger Siewert, executive medical director and chairman of the Board at Heidelberg University Hospital – said their hospitals had achieved a favourable balance. However, Barbara Schulte, Member of Board and head of the management and administration department at Göttingen University Hospital and Prof Karl Max Einhäupl, chairman of the Executive Board of Charité Medical School in Berlin reported that their hospitals are still in the red. In 2007, Göttingen university hospital had a budget deficit of ?20 million and, in 2008, Charité faced a deficit of ?56 million.
The crisis also has political and economic aspects; State control is still too powerful and bureaucratic obligations confining. It would therefore make sense for university hospitals to have more entrepreneurial freedom and more freedom to make their own decisions. Prof Einhäupl, for example, pointed out that for 2009 the Charité planned to reduce its deficit from over ?50 million to ?19.5 million, i.e. saving ?37 million – an extremely difficult task because more than 50% of the budget is spent in personnel. Hence, releasing personnel is absolutely essential to meet economic obligations. Due to legal regulations, the majority of employees can be released by so-called enforced redundancy. However, in the Berlin area, where Charité is located, enforced redundancies are currently banned. ‘This is our dilemma,’ Prof Einhäupl explained.
Prof Holzgreve (Freiburg) mentioned the importance of internal decision-making for financial profitability and international competitiveness. At Freiburg the number of patients and the third-party funds have increased in recent years, which is why the university hospital has an acute space shortage, not only for research but also simply for beds. This is one reason for a merger, planned for 2010, of the cardiovascular department with the private heart centre Bad Krozingen. Due to underfunding, the university hospital cannot create new buildings, which is why Prof Holzgreve pleaded for more economic freedom for action. After the merger, the joint heart centre will be one of the biggest in Europe.
Prof Einhäupl suggested three possible answers to the university hospitals crisis: merger, privatisation or marginalisation. Along with this, he pointed out common strategies to cope with the crisis, among them that a hospital should be treated and managed like a company. Economic tools should be implemented, such as controlling, transparency or an increase in professionalism within leadership. Furthermore, a focus on special fields of research is necessary, as well as concentration on core areas in applied medicine. This includes closing some departments and research areas. Dr Tecklenburg, for example, mentioned that, within their period of consolidation, which started five years ago, the Hannover Medical School eliminated 11 academic Chairs. Finally, departments that fit together should be amalgamated.
Only cross-subsidisation was controversially disputed. Prof Einhäupl pointed out that his experience from evaluating more than a dozen university hospitals showed that a favourable balance is only achievable at the expense of research. Disagreeing, Dr Tecklenburg emphasised that research at Hannover Medical School was not reduced in favour of profitability.
In conclusion: There is considerable need for greater freedom to manage university hospitals with economic tools – like a company in a free market economy.
* Source: The German university hospitals association
01.09.2009
