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.
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.
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.
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
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