The Bundestag votes this Thursday on the reform of emergency care. As tagesschau.de reported on Thursday morning, the law is to be passed on this 15 October. The aim is that only people who really belong there end up in the emergency department. According to experts, around 30 per cent of patients in emergency departments are not actually emergencies.
Federal Health Minister Carsten Linnemann (CDU) did not blame patients. “But it is we politicians who have made the regulation in such a way that steering in the healthcare system does not work,” Linnemann told the ARD-Hauptstadtstudio. The reform is long overdue. In fact, according to tagesschau.de, the black-red coalition is the third government in a row to want to implement an emergency reform.
What changes for patients
The core element is a telephone or digital initial assessment. For this, the emergency number 112 and the number of the medical on-call service 116 117 are to be linked. Anyone who calls is assessed medically. In an acute emergency, an ambulance still comes. If the case is less urgent, treatment should take place in an on-call practice or a normal doctor’s practice; in some cases, according to Tagesspiegel, the 116 117 hotline can also advise curing the illness in bed.
In addition, around 750 integrated emergency centres are to be created at hospitals, consisting of an emergency department, an on-call practice and a joint initial assessment point. There it is decided whether someone belongs in the emergency department or can be treated in the on-call practice. People who have obtained a recommendation for the emergency department in advance via 116 117 are to be treated faster if the urgency is the same. “Anyone who has an emergency should get help quickly. That is the central claim of our healthcare system,” Linnemann told the “Bild” newspaper.
Something is also changing for the rescue service: emergency doctors and paramedics no longer have to bring patients to the emergency department, but can also treat them at home or take them to an on-call practice. For this purpose, the missions will in future become a separate service covered by the health insurers; until now they were merely billed as an extended transport service.
How much money is the reform supposed to save?
According to Tagesspiegel, based on model projects, the Federal Government expects that telemedical advice will make visits to an emergency department or on-call practice unnecessary in 1.2 million cases. In the long term, the statutory health insurers are to save 1.2 billion euros per year as a result. A further billion could be added because unnecessary inpatient admissions are eliminated.
For the Greens, this does not go far enough. Their health policy spokesman Janosch Dahmen, himself an emergency physician, sees a savings potential of three to four billion euros per year if implementation is more consistent. Hospitals receive only around 50 euros for the outpatient treatment of emergency patients, but 1500 to 5000 euros for an inpatient admission, Dahmen told Tagesspiegel. “It is worrying that the black-red coalition is not eliminating this perverse incentive,” said Dahmen. He fears that emergency departments will remain overcrowded because people wait too long for regular doctor’s appointments.
Resistance from the rescue service
Major aid and rescue organisations are demanding improvements. The Secretary General of the German Red Cross, Christian Reuter, demanded on Tuesday that the law not be brought through the Bundestag as planned. Otherwise it would become economically difficult for many rescue services. Rescue services such as Johanniter-Unfall-Hilfe, Deutsche Luftrettung and Malteser had set up rescue helicopters and ambulances in front of the Brandenburg Gate to campaign for changes. Krystian Pracz of DRF Luftrettung pointed to dependence on international markets: “Everyone notices at the petrol station how high fuel prices are. We notice that with the kerosene for the helicopters too.”
The coalition has made improvements in the final stages. According to Green MP Dahmen, the rescue service will therefore also be properly financed in future; rescue services would have to demonstrate their economic efficiency more transparently to this end. “I consider that feasible and appropriate,” said Dahmen. According to morgenpost.de, the National Association of Statutory Health Insurance Physicians warns of “new parallel structures”. Henriette Neumeyer, deputy head of the German Hospital Federation, criticised in “Bild”: “Central demands of the hospitals remain unconsidered in the present draft law.”
According to the Federal Statistical Office, 13 million outpatient emergencies were treated in hospitals in Germany in 2024. In Hesse, essential building blocks of the reform are already in use or being tested in model projects, as fr.de reports. The Association of Substitute Health Insurance Funds (vdek) is emphatically advocating the nationwide reform; its chairwoman Ulrike Elsner calls a standardised initial assessment procedure the most effective instrument against overcrowded emergency departments. Between 2023 and 2025, statutory health insurance expenditure on ambulances and air rescue rose by more than 20 per cent.
Editor’s note: Whether the reform brings the hoped-for relief will only become clear after the emergency centres have been established. The Bundestag intends to launch further structural reforms such as the primary care model.
