92 2 ECONOMIC REPORT 2.1 MACROECONOMIC ENVIRONMENT Compared with the European context, the trend in the German economy once again proved stable and robust in 2013. That said, the persistent recession in some European countries and weaker global economic performance were also felt here. Exports rose by only 0.6%. These influences could not be offset by stronger domestic demand, either. And although the German economy was still growing, with a 0.4% rise in gross domestic product (GDP), this was still well below the level of the previous two years. In 2011 GDP was up 3.3%, and in 2012 the increase was still 0.7%. The prospects, however, are good. After a weak phase last winter, the German economy once again gathered pace in the course of 2013. But the new expansion is no longer being driven exclusively by foreign trade. Domestic de- mand (particularly private consumption) is now also pro- viding a much stronger boost, helped by sustained (albeit weaker) growth in employment, the resulting low unem- ployment rate and noticeable growth in income. Another favourable effect is the low level of interest rates. Given the nascent revival of the global economy and thus ex- ports, the Deutsche Bundesbank sees the possibility of further growth by 1.7% this year and 2% in the coming year. Over the past year, services once again contributed a good deal to this overall pleasing development. 2.2 HEALTHCARE INDUSTRY In 2011, healthcare spending in Germany totalled 293.8 billion, of which 76.8 billion went for the hospital sector. More recent figures are not yet available. Based on the rate of increase of the statutory health insurance funds whose expenditures on healthcare for their members rose in 2012 by 9.3% from 168.5 billion to 184.2 billion, the total is probably in the range of at least 320 billion. Assuming an unchanged share of hospitals of 26%, this sector would account for over 83 billion ­ the amount that has to be divided up among some 2,000 German hospitals (in 2012 the number of hospitals was still 2,017 and falling). For quite some time it has become increas- ingly clear that the financial basis of many hospitals is in- sufficient. According to the 2013 Hospital Rating Report, 27% of the roughly 2,000 hospitals are threatened by in- solvency. The situation did see a slight improvement with the new provisions on the orientation value (Orientierungswert) introduced at the beginning of August 2013. The purpose of the orientation value, to be calculated by the German Federal Statistical Office (Destatis) from the trend of vari- ous cost components, is to define the scope of price ad- justments for hospital services. Originally, it was to com- pletely replace the rate of change in aggregate income (Grundlohnrate) as the assessment basis. Under the new provision, however, the orientation value is compared with the rate of change in aggregate income, with the higher value being applied. For the current year 2014 the rate of change in aggregate income will be applied. During the past year 2013, the effects of the emergency funding for hospitals adopted by the German govern- ment could already be felt. To cushion the negative im- pact of the new collective bargaining agreements, DRG remuneration rates were raised by 0.21% and the budgets for psychiatric hospitals by 0.26% in 2013. It will of course take much more than that to fix Germa- ny's hospital finance problem. The hospitals are still strug- gling with the pressures of personnel expenses. The Ger- man Hospital Association (DKG) takes the view that while the coalition agreement imposes the highest require- ments on hospitals, it makes only rudimentary statements (or none at all) on how funding might be improved to ensure that hospitals operate efficiently. One ongoing bone of contention is that the federal states are still falling far short of meeting their statutory invest- ment finance obligations. The DKG estimates the annual investment requirement at roughly 6 billion, versus an actual funding provision of only 2.7 billion. That is why the hospitals are not very impressed by the investment programme totalling 500 million. Some of the measures provided for under this programme include the conver- sion of hospitals into nursing and care centres providing outpatient treatment with a view to reducing overcapaci- ties. Funding is not the only thing the sector is worried about. Already in the foreseeable future, many hospitals expect to face shortages in qualified staff. According to the "Hos- pital Barometer" of the German Hospital Institute (DKI), the OR and intensive care areas are the worst affected by the shortage of specialists. 40% of hospitals have prob- lems filling vacancies in intensive care. 29% have prob- lems filling vacancies for non-physician OR staff, and 18%
RHÖN-KLINIKUM AG Download Center Language
  • English
  • Deutsch