Bavaria’s districts and the Munich rescue service association reject the federal government’s planned reform of emergency care because of the cost burden on municipalities and are calling for improvements. As the Süddeutsche Zeitung reported on Tuesday, 10 November, the president of the Bavarian District Association, Thomas Karmasin, called on Minister-President Markus Söder (both CSU) to stop the bill in the Bundesrat without corresponding corrections and to convene the mediation committee. The Bundesrat’s final consideration is scheduled for 20 November.
The Bundestag had already passed the reform on 15 October. From the point of view of the Bavarian districts, it leaves important financing questions open and at the same time weakens municipal co-determination. “Should the improvements at federal level fail to materialise, the Free State must cover the uncovered costs that arise. Neither the aid organisations – including the Bavarian Red Cross, the Malteser Hilfsdienst and the Arbeiter-Samariter-Bund – nor the districts and independent cities can shoulder a structural deficit in the long term,” Karmasin stressed, according to the Süddeutsche Zeitung.
“These costs must be borne entirely by the social insurance institutions”
Hans Reichhart (CSU), district administrator of Günzburg and chair of the District Association’s committee for municipal affairs, law and education, also demands full financing through social insurance. “The rescue service must be ready for action 24 hours a day. That costs money – even when no ambulance is currently on the road. These costs must be borne entirely by the social insurance institutions. It cannot be that the districts have to step in because statutory financing is insufficient,” Reichhart said. At the same time he warned: “One thing must not happen: the municipalities bear responsibility for a functioning rescue service while others determine how it is designed and the financing gaps remain on the ground.”
In Bavaria, the districts are responsible for emergency care. Together with the providers, they organise, coordinate and secure assistance on the ground, but according to their own account they need reliable financing conditions and genuine decision-making powers to do so.
Munich association: 330,211 deployments in 2025
Support comes from Munich. According to the city of Munich, the Munich Rescue Service Association (RZV) is appealing to the Free State to convene the mediation committee, as tz.de reports. The association welcomes the fact that medical emergency rescue is to be anchored in future as a separate benefit of statutory health insurance. However, in the version adopted, the financing of the reform is not sustainable.
In a letter to the Bavarian state ministers Judith Gerlach, Florian Herrmann and Joachim Herrmann, the RZV demands four concrete improvements: the so-called standby costs for ambulances and emergency personnel ready around the clock must be refinanced by law regardless of the actual volume of deployments. If personnel costs rise due to collective agreements or if the Free State prescribes additional ambulances, the health insurers must take these additional costs into account appropriately. In addition, the planning authority of the federal states must be preserved so that the Free State and the associations continue to decide on the need for ambulances. Equally important is binding participation of the municipal umbrella organisations in the specialist committee with three seats.
The RZV Munich is responsible for the state capital and the district of Munich and, according to its own information, serves just under two million residents. In 2025 it carried out 330,211 deployments, an average of more than 900 per day. Standby provision includes not only the ground-based rescue service but also the rescue helicopters Christoph 1 and Christoph München as well as additional capacities for major events such as sports events, concerts and the Oktoberfest.
“Responsibility for care and responsibility for its financing must not fall apart,” explained Hanna Sammüller, head of the district administration department and chair of the RZV Munich. Every financing gap jeopardises reliable care for the population. District administrator Christoph Göbel, deputy chair of the association, stressed that the planning authority of the federal states and the rescue service associations must not be undermined by the reform. Those responsible on the ground for an efficient rescue service must also be able to decide on the necessary structures and capacities in future. Sammüller finally called on the Free State to work in the mediation procedure towards sustainable financing of emergency rescue.
Editor’s note: Whether the Free State covers the uncovered costs or the Bundesrat convenes the mediation committee remains open – both are demands of the municipalities. What is decisive is the Bundesrat’s final consideration on 20 November.
