Another 1.16 billion euros for restructuring…

Bonn – The federal states have been able to receive financing for the restructuring of the hospital landscape and the restructuring of clinics with funds from the hospital structure fund since 2016. However, the most recent data shows that many funds have not yet been accessed. There are currently more than one billion euros available, according to the Federal Social Security Office (BASIS) upon request from the German doctors­sheet explained.

According to the authority, the federal states still have around 1.16 billion euros available for their own state projects and 94.4 million euros for interstate projects. Resources must be requested by December 31, 2024. Financing from the hospital structural fund is intended to contribute to improving hospital care structures. The available funds have been repeatedly increased through various laws since 2016. Up to two billion euros are planned by the end of 2024.

On May 6, 2024, the federal states requested funding totaling €807.8 million for state-specific projects and €5.4 million for interstate projects, the BAS explained. The 5.4 million euros have already been paid in full. 663.8 million euros were spent on the State’s own projects.

In the course of the planned hospital reform, the federal states repeatedly had to pay the planned amount more quickly Transformation Fund to support the restructuring of the hospital sector. However, BAS figures show that there are still many resources available in the hospital structural fund for similar restructuring.

BAS explained that so little money was only mobilized because states could have focused on the subsequent future hospital fund. This includes a financing volume of up to 4.3 billion euros and should mainly allow for an improvement in digital infrastructure. The federal states had to apply for the corresponding funding projects by December 31, 2021.

“This is supported by the fact that the number of applications for the hospital structural fund has increased recently,” continued the BAS spokesperson. Furthermore, states must coordinate corresponding applications with cost bearers, i.e. health insurance companies, and contribute at least 50 percent of structural fund financing.

It is interesting that some federal states have not yet presented any or almost no applications for structural funds. Thuringia, for example, has not yet submitted a candidacy. Due to the distribution of the Königstein Key, 50.8 million euros are available for state projects in Thuringia.

This is mainly due to the objectives of the Hospital Structure Act (KHSG) of December 2015, which forms the basis of the fund, where proof of reduction in inpatient care capacities is determined as a crucial approval requirement for the main part of financing. , writes a spokeswoman for the Thuringian Ministry of Health hospital. “These factors make it considerably more difficult to develop eligible projects in Thuringia and, ultimately, to submit applications to the federal government.”

Structural changes have already been made

In Thuringia, major structural changes in hospital care already took place around the turn of the millennium. The result was an offer of high-quality hospital care based on the needs of the population.

It is therefore difficult for hospital authorities to define projects that meet the requirements of the structural funds, unlike other federal states, for example, which carry out processes such as the aforementioned restructuring of the hospital landscape with the help of the KHSG, in accordance with the Thuringia.

The spokesperson announced that funding from the Structural Fund for the conversion of emergency rooms, for example the creation of integrated emergency centers (INZ) and the creation/expansion of nursing schools in hospitals, will probably be presented by Thuringia by the first half of 2024. Thuringia also submitted many applications to the Hospital Future Fund, there was a greater need for structural measures here;

Rhineland-Palatinate also submitted almost no applications, up to 91.7 million euros are available to the state. The country will submit corresponding applications by the end of 2024 and exhaust available funding, said a spokesperson for the local Ministry of Health.

NRW: Concentration projects and planned KRITIS applications

North Rhine-Westphalia (NRW) has also only requested around 23 percent of its available quota so far. 400.9 million euros are available for the West German state. In North Rhine-Westphalia there are many metropolitan areas with an excess of inpatient care, as well as rural regions where comprehensive care is sometimes difficult. However, NRW intends to use almost all available federal funds, according to the Düsseldorf Ministry of Health.

“According to the current state, a total of six concentration projects and 27 KRITIS applications (for adapting the information technology of hospitals that are part of the critical infrastructure) are being pursued to finance the structural funds”, explained a spokesperson. Applications were submitted for four concentration projects, with the rest still being prepared.

NRW also explains the delay with the requirement that hospital authorities submit extensive and concrete planning documents for the planned construction projects. “In addition, due to the increase in the construction price index, changes to the plans for some projects have become necessary. For this reason, preparing applications for submission to the Federal Social Security Office takes a long time,” said the spokeswoman for North Rhine-Westphalia.

Berlin has also barely requested any funding so far. However, the city-state is entitled to 96.6 million euros. The Senate is currently analyzing five measures that are expected to be submitted to the BAS by the end of 2024, said a spokesperson for the Senate Health Department in Berlin.

However, only state funds of 49.3 million euros are earmarked for the double budget 2024/2025 for the necessary co-financing until 2027, the spokesperson explained. This means that Berlin will probably only be able to access half of the federal funds.

Projects must be implemented promptly

A special case also occurred in Schleswig-Holstein. The entire funding amount of €64.8 million has already been requested but has been transferred back, according to an overview from BAS German medical journal is present.

“At the end of 2023, Schleswig-Holstein withdrew the application – which had already been approved – because the planned implementation deadlines for the planned large project to merge the Diako Hospital Flensburg and the St. Franziskus Hospital Flensburg were too tight,” explained a spokesperson for the Ministry of Health in Kiel.

A new timetable has been agreed with BAS and funds remain reserved for the state. Schleswig-Holstein therefore plans to submit another application for the major merger project in Flensburg.

The hospital structure fund in accordance with Section 12a of the Hospital Financing Act (KHG) has existed since January 1, 2016. It initially served mainly to reduce excess capacity, concentrate inpatient care offers and locations, and convert hospitals into non-acute hospitals. local inpatient care facilities.

A total of two billion euros in funds are available until December 31, 2024. Around 99 percent of these come from the health fund’s liquidity reserve, with the remaining funds provided by the agricultural health insurer.

Federal states can apply. 95 percent of the funds are earmarked for projects in the respective countries, five percent for cross-border restructuring. Funds are distributed according to the Königstein key from October 1, 2018.

The prerequisite for financing is that candidate countries, possibly together with the institution to be financed, contribute at least 50 percent of the eligible costs for the project. The BAS is responsible for examining states’ requests for the disbursement of structural fund financing and for allocating the funds. © cmk/aerzteblatt.de