Germany's ailing emergency healthcare service needs a revamp

German emergency services suffer from major inefficiencies and wildly different services across the country, according to a new investigation that has raised serious questions in a country with some of the highest numbers of medical personnel in the world.

The investigation released this week by public broadcaster SWR found that only 24 of Germany's 283 emergency service* districts could say that they could reach cardiac arrest cases within eight minutes — the time limit recommended to successfully save someone's life in urban areas. Some 130 said they could not make this target, while the rest could not offer any data. According to SWR, some 10,000 people die in Germany every year whose lives could be saved.

The report also found huge variations in the standards that the different German states impose on their emergency services — while some states, like Hesse, require emergency services to reach patients within 10 minutes of the emergency call, in neighboring Rhineland-Palatinate the target is 19 minutes.

Expensive and inefficient

And yet Germany doesn't appear to lack money for health care — according to the European Commission, the country has the highest healthcare expenditure relative to GDP of any EU country, with 12.8% in 2020, and it has 7.9 beds per 1,000 inhabitants, while the EU average is 5.3. Still, the SWR investigation showed emergency services often find themselves overworked and understaffed.

Janosch Dahmen, health policy spokesperson for the Green Party, thinks the problem is inefficiency: "This starts with the fact that, unlike in the UK, Denmark or the US, when someone calls the emergency services, we do not operate a standardized, quality-assured emergency call center, but instead each call taker does what they think is right, so to speak, according to their best judgment or conscience."

Dahmen, who himself worked as an emergency doctor until 2020, and says he went into politics partly because of the systemic problems he encountered, believes that too often, ambulances are sent to an emergency where they shouldn't have to go, and where other medical assistance would be much more appropriate. "Conversely, this also means that very dramatic emergencies, such as a cardiac arrest, cannot always be treated professionally in the medically required time," he said.

The Health Ministry's idea

According to the Health Ministry, some 30% of cases that end up in hospital emergency rooms don't require emergency treatment, which is precisely the issue that Health Minister Karl Lauterbach is seeking to tackle with his new reform, presented to the federal government's Cabinet earlier this week.

The central idea of Lauterbach's plan is to introduce a central desk in some hospitals, which decides whether a patient should go to the emergency room or wait for a regular appointment. Similarly, emergency calls are to be directed more carefully to the care they need, with the help of standardized responses. Doctors are also to make more use of video and telephone consultations.

"At the moment, we still have a comparatively large number of emergency personnel, both in relative and absolute terms, more than many neighboring countries that have organized emergency care much better," said Dahmen. The aim is to deploy those personnel in a more targeted way and to link alternative and more suitable forms of care more closely to the dispatch centers.

Something like this already happens in other countries. In the UK, there are special services for mental health emergencies and emergencies in nursing homes for the elderly. These can often deal with specific problems in situ, without patients having to be taken to hospital at all.

Denmark, meanwhile, has introduced so-called "sociolances" (a portmanteau of social service and ambulance), specifically trained for the homeless and other vulnerable people and designed to prevent emergencies from happening in the first place.

Skepticism among doctors

However, some healthcare professionals remain skeptical that Lauterbach's reform will work. Vincent Jörres, spokesperson for HAEV, Germany's Association of General Practitioners, agreed that the basic problem was that patients weren't being directed to the right places — but thinks Lauterbach's reform will only exacerbate this problem, as patients will have even more choices and more different types of clinic to go to.

"So in the future, we're supposed to have the normal doctor's offices, the hospitals, the on-call practices at the hospitals, the 24/7 emergency services, and the 24/7 telemedicine service," he told DW.

The HAEV also fears that, since it is not yet clear how many hospitals will have the extra central desks, and which staff are supposed to cover all these services, much of the extra burdens will fall on general practitioners. "The staff resources simply aren't there," he said. "This reform will just shift the problem in emergency services into the practices, especially the general practitioners."

Staffing remains a complicated issue. Though it is true that Germany has a relatively high number of medical professionals, Germans also go to the doctor more often than in other countries. According to OECD figures, the average German sees a doctor 9.8 times per year, compared to the EU average of 6.7. "In our opinion, this is down to the fact that they go and see too many different doctors, because they don't know where to go with what problem," said Jörres.

Dahmen insists that the new reform will help to deal with that very problem, and believes it represents a vital step forward: Past attempts at reforming emergency care often failed, he noted, not because of any political argument, but because of jurisdictional rows between Germany's different levels of government: The federal, the state, and the municipalities. Though this reform left questions open, he believes it is an important step towards making emergency services more targeted, and therefore unburdening the healthcare system as a whole.

Edited by Rina Goldenberg

*When in Germany, in case of a health emergency call 112.

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