The Bundestag passed the reform of emergency care on Thursday. As tagesschau.de reports, around 750 integrated emergency centres are to be set up at hospitals, better linking inpatient and outpatient care and available around the clock. The law is due to come into force in 2027. The aim is for people with acute complaints to get the right help faster and for minor cases not to end up in A&E in the first place.
On Thursday morning the reform was still in the parliamentary process, as the taz reported. Parliament has now approved it. The core of the reform is better steering of patients: a telephone or digital initial assessment is to clarify whether a case belongs in a doctor’s practice, an out-of-hours practice, an emergency centre or a hospital. The emergency number 112 and the number of the medical on-call service 116 117 are to be more closely linked for this purpose.
Why the reform is necessary
Accident and emergency departments in Germany have been overloaded for years. According to figures from the Federal Statistical Office, which the authority released last December, around 13 million outpatient emergency cases were treated in German hospitals in 2024 – an increase of five per cent on the previous year and the highest figure since records began in 2018. On average, the emergency departments thus treated around 35,600 people a day.
A survey published on Tuesday by the German Society for Emergency Medicine shows how tense the situation is: almost every second A&E department considers itself overloaded, in some cases so severely that patient safety can be at risk. 60.6 per cent of hospitals cited as a reason that patients could not be transferred to regular wards because there were no free beds there. Almost two thirds of hospitals reported unfilled posts in A&E in the medical service or in nursing. Only just under a third rated staffing levels as sufficient.
Doctors and paramedics also report misdirection: many people use A&E or the emergency number even for minor problems, chronic illnesses or loneliness. In the emergency services there are many unnecessary journeys, according to the taz report.
What changes for patients
The reform relies on three building blocks: hospital A&E departments, the out-of-hours practices of the regional association of statutory health insurance physicians and, in perspective, a digital initial assessment. They are to work together in the integrated emergency centres. Additional out-of-hours practices are to relieve pressure on A&E departments at fixed times, for example at weekends.
Home visits by a medical on-call service will continue to exist, but only when neither referral to a doctor’s practice nor telemedical treatment nor care in an emergency centre is suitable in the individual case. For minor illnesses, video consultations are to save journeys and waiting times.
The number 116 117 will in future be split into an appointment service and an acute control centre. The acute control centre is to direct outpatient emergency and acute cases to the right level of care and link up digitally with the 112 rescue control centres to form a health guidance system. For acute cases, telemedical and outreach on-call services are to be available nationwide and around the clock under 116 117 as initial care. In case of danger to life or serious health emergencies, 112 remains directly reachable – nothing changes here.
Another new feature is that emergency rescue is in future to be classified as a benefit in kind of statutory health insurance. Medical emergency management, care on site and specialist medical supervision during transport are to be recognised as part of medical treatment. This is intended to prevent insured persons from having to bear part of the costs themselves.
Emergency services: states remain responsible
The states remain responsible for the regional planning and organisation of emergency services. However, the federal government is pressing for better digital equipment and networking: ambulances are to transmit important information about the patient’s condition to hospitals or doctors’ practices in a standardised way. A technical system for displaying current hospital resources is to become mandatory. For digitalisation, the federal government is providing 225 million euros in funding from the Infrastructure and Climate Neutrality special fund.
Measures for faster initial care in cases of sudden cardiac arrest are also planned. In all rescue control centres, instructions for resuscitation are to be given over the phone. In addition, the rescue control centres are to be networked nationwide with first-responder apps so that voluntary helpers in the neighbourhood are alerted immediately in the event of cardiac arrest and can initiate first measures.
Experts have for years complained of a “completely fragmented responsibility” of emergency services due to federal structures. The Björn Steiger Foundation from Winnenden has lodged a constitutional complaint against the federal government and the federal states because politicians are not providing a fully functioning, nationwide emergency services system.
The reform of emergency care has been discussed for years. As early as 2019 there was an attempt, which initially failed because of resistance from the federal states and later because of the coronavirus pandemic. The traffic-light government also had the reform on its to-do list as part of the major hospital reform in autumn 2024, but the break-up of the coalition caused another postponement. Now the law is due to come into force in 2027.
Editor’s note: The reform is a central building block for relieving pressure on A&E departments. Whether the planned 750 emergency centres and the digital steering will be enough will only become clear after the start in 2027. The decisive factor will be whether enough staff can be recruited for the new structures.
Earlier coverage: Bundestag votes on emergency care reform
