The German Health Ministry, under Minister Nina Warken (CDU), is proposing a sweeping overhaul of emergency medical services aimed at alleviating pressure on overburdened hospitals and emergency rooms while simultaneously generating billions of euros in savings, according to a report in the Frankfurter Allgemeine Zeitung. The proposed legislation, currently in internal review, introduces a tiered system intended to streamline access to emergency care and curtail what officials describe as the inappropriate use of vital resources.
At the core of the reform is a mandatory initial medical assessment, to be conducted either by telephone or in person, to differentiate genuine emergencies from less urgent cases. While patients will retain the ability to access emergency rooms without an appointment, the ministry anticipates significantly faster treatment times for those who first contact the emergency medical advisory line, 116117 and present proof of this assessment at the ER. The proposed system incentivizes prioritization, potentially marginalizing individuals seeking immediate care without the preliminary triage.
A key feature of the plan involves the nationwide establishment of Integrated Emergency Centers (INZ), collaborative facilities uniting hospital staff and general practitioners operating around the clock. Patients will be directed to either the emergency department or an out-of-hours GP practice based on the assessed urgency of their condition. In cases deemed non-emergency, patients could be referred back to routine care, raising concerns about accessibility for vulnerable populations and the potential for delayed treatment.
The ministry asserts that approximately one-third of emergency room visits are deemed unnecessary, justifying the proposed reforms. The plan seeks to digitally link emergency telephone numbers 112 and 116117, aiming for standardized initial assessments and direct routing to the most appropriate care setting. Initial projections estimate savings of up to €2.3 billion annually through this digitalization effort, including a reduction of 1.21 million emergency service calls.
Further bolstering the plan is a proposed restructuring of emergency medical service billing, moving them from a reimbursement-for-transport model to a standalone segment within the Social Code. This change aims to alleviate the substantial out-of-pocket expenses patients currently face-potentially exceeding €2,000 per emergency deployment-by integrating service costs directly. Projected short-term savings for the first year are estimated at nearly €300 million, escalating to over €1 billion annually in the long term. Significantly, the largest savings are anticipated (€700 million annually) through the redirection of patients from emergency response dispatch to routine GP care.
Critics are likely to scrutinize the plan’s potential impact on patient access and equity. Concerns regarding the potential for delayed care due to mandatory triage and the feasibility of a fully integrated system – particularly in rural areas facing physician shortages – are expected to emerge. The reliance on telemedicine and digital infrastructure also raises questions about accessibility for individuals lacking technology or digital literacy, potentially widening health disparities. The plan’s efficiency-driven approach requires careful consideration of its potential impact on vulnerable populations and necessitates ongoing monitoring to ensure equitable access to crucial emergency services. The cabinet is expected to discuss the proposal formally in early next year.
