20.08.2018  |   Advisory Report

Funding of ground and air rescue transport services

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0 Executive Summary

The German SAI audited the funding of ground and air rescue transport services provided to statutory health insurance enrolees. We have confirmed the following findings as final.

The federal states and the municipalities are responsible for providing rescue services. They decide about establishing ambulance stations and air rescue stations. In its financial provisions, the German Constitution generally imposes funding responsibility for rescue services on the federal states. However, the statutory health insurers have the statutory duty to pay the transport costs where such transport is needed to provide urgent health-related services for compelling medical reasons. There are no detailed legal provisions in place to determine the amount of those transport costs. The federal states and municipalities apportion the costs to the statutory health insurers by way of fees and user charges. In recent decades, they have continuously reduced funding of rescue services. As a result, statutory health insurers do not only bear transport costs but also provide almost all funding needed to maintain and deploy ambulance cars and rescue helicopters. Still, health insurers have practically no say on procurements and locations of ambulance or air rescue stations. Their expenditures on ground and air rescue transports have risen considerably in the last 25 years. They totalled €3.5 billion in 2017.

Divergent responsibilities for providing and funding rescue services are likely to encourage inefficient decisions. We recommend that the costs to be borne by the statutory health insurers are clearly separated from the costs to be borne by the federal states. At the same time, the statutory health insurers should be given participation rights commensurate with their funding share. In order to ensure that the statutory health insurance enrolees are not imposed the costs for setting up and maintaining the rescue services, the federal states should be involved at an early stage in any initiatives designed to revise cost sharing arrangements.

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