More and more clinics threatened by bankruptcy

"Bad Bank "for hospitals could allow settlement
Many hospitals in Germany write significant losses, so one of the key messages of the Hospital Rating Report 2015, which was presented to the public in the context of the "Capital Congress 2015 - Medicine and Health" in Berlin. In order to be able to better absorb any insolvencies, the experts are proposing a kind of "bad bank" for hospitals. The report was prepared by the Rheinisch-Westfälische Institut für Wirtschaftsforschung (RWI), the Institute for Healthcare Business GmbH (hcb), the Münch Foundation and the Philips GmbH.

According to the Hospital Rating Report, the probability of insolvency of German hospitals in 2013 increased slightly compared to the previous year. According to the experts, 16 percent of the clinics were in the "red zone" with increased risk of bankruptcy. Although the earnings situation improved (return on sales increased from 0.7 to 1.4%), the proportion of clinics that posted a year-on-year loss at Group level fell slightly (from 33% in 2012 to 30%) and increased their ability to invest (56% instead of previously 48% of clinics fully eligible for investment). But "the capitalization of hospitals is still inadequate," according to the RWI release on the latest report. If the status quo is updated, the proportion of hospitals with a higher risk of insolvency is expected to rise to 27 percent by 2020. In order to better handle the imminent closures, the establishment of a kind of "bad bank" for hospitals is recommended.

Nearly every third public clinic is threatened by bankruptcy. (Image: Kurt Kleemann / fotolia.com)

Billions investment backlog at the clinics
The current annual investment requirement of the hospitals amounts to about 5.3 billion euros - without the university hospitals. At present, only half of these countries contribute and the accumulated investment backlog amounts to at least 12 billion euros. Although the upcoming Hospital Structure Act could prevent further deterioration by 2020, it is not possible to foresee a fundamental improvement in the financial situation at the clinics. Here, in addition to productivity advances, market exits from economically weak houses are required to reduce the share of clinics in the "red" area, according to the RWI. At this point, the "bad bank" for hospitals could help. According to the experts, a corresponding fund would have to have an initial budget of approximately € 2.7 billion.

Nearly a third of public-health clinics threatened by bankruptcy
A look at the financial situation of the hospitals by institution shows that public hospitals in particular are increasingly struggling with financial difficulties. Of these, 29 percent were in the red zone in 2013. Of the non-profit, 14 percent were in the area of ​​a bankruptcy risk and of the private five percent. "At the same time, all sponsoring organizations had to accept a decline in recent years," according to the RWI announcement. Especially in Bavaria, Baden-Württemberg, Hesse and the northwest, the situation of many public-law houses is critical. On a regional level, clinics in the eastern German states were best, followed by North Rhine-Westphalia. Most problems have clinics in "Lower Saxony / Bremen, Baden-Württemberg, Bavaria and Hesse," reports the RWI. A deterioration compared to the previous year was recorded in particular in Hesse, Bavaria and Baden-Württemberg.

Structures unfavorable in many regions
The Hospital Rating Report concludes that hospital structures in many regions are unfavorable. Too many small units, too high hospital density and too little specialization, are the problems. In eastern Germany, however, the structural adjustments of recent decades have borne fruit. In general, a high degree of specialization had paid off both in economic terms and in terms of quality, and in addition "hospitals with high capital expenditure, i. Investment, more economically positioned ". So far, only a few market exits have taken place in the hospital sector, although security of supply in almost no region would be jeopardized.

Active Structural Funds for the administration of the clinics
In order to be better able to cope with possible future market exits, the scientists are proposing a further development of the Structural Funds planned by the legislator into a kind of "bad bank" for hospitals. Such an "active Structural Funds" could be used by hospitals to liquidate, "if the institution is neither eligible for redevelopment nor for sale and the site does not need to be maintained for supply," according to the RWI. However, according to the experts, "at the same time nationwide minimum requirements for the accessibility and quality of hospitals and emergency care should be formulated." The fund would have to the imagination of the scientists on the one hand, the cost of demolishing or possibly the reallocation of the property On the other hand, he could also earn revenue by offering the previously agreed casemix points of the hospital to be closed without a fixed cost degression to other providers in the region.

"Bad Bank "for clinics would need 2.7 billion euros of capital
If all insolvent-endangered, non-care-relevant hospitals transferred to the Fund with a loss per year and less than 400 beds, according to the experts, processing costs of about 4.3 billion euros would result. However, the sale of the Casemixpoints licenses could generate revenues of an estimated € 1.6 billion. Thus, the Fund would need an initial € 2.7 billion to complete the winding-up of the vulnerable clinics. He should be fed from federal funds and can act independently of the countries, so the proposal of the scientists. They assume that overall demographic change requires more efficient healthcare. Especially after the year 2020, demographic change will become increasingly noticeable in the healthcare sector.

More efficient healthcare needed
More old and fewer young people will not only increasingly overburden social security systems after 2020, but also make hospital staff scarcer and more expensive, according to the RWI. Therefore, in the medium term, a much more efficient healthcare is required to counteract rationing in medicine. The necessary efficiency improvements seem to be achievable only at the level of regional or national and integrated networks. This is not only about cost reductions, but also about improved medical care quality and better case management. (Fp)