Rescue services: Costs frequently passed on to statutory health insurers
Rescue services are jointly funded by the federal states, the municipalities and the statutory health insurers. However, the statutory health insurers are increasingly burdened with these costs. This is the result of work the German SAI did on the funding of ground and air rescue transport services.
“Each year, statutory health insurers pay €3.5 billion from enrolees’ funds and federal funds for rescue services, while the federal states and municipalities have more and more withdrawn from funding. This practice neither complies with applicable legislation nor does it promote efficient management. It burdens the community of the insured” said Kay Scheller, President of the German SAI when issuing the report to the Budget Committee of the German Parliament.
In the last 25 years, the expenditures of the statutory health insurers for transport by ambulance cars and rescue helicopters have increased from € 700 million to € 3.5 billion. Although the federal states also need to fund part of this, several states have for years stopped funding ground rescue services and now apportion all costs to the statutory health insurers. Other federal states have reduced their funding significantly.
The German constitution stipulates that the federal states shall provide rescue services. In line with legislation in each respective federal state, municipalities fund ground rescue services and the states fund airborne rescue services. This also includes capital expenditure on establishing and operating ambulance stations or air rescue stations and staff expenditure.
Statutory health insurers shall fund the transport costs where such transport is needed to provide urgent health-related services for compelling medical reasons. However, transport costs are not precisely defined. Charging practices differ widely among federal states.
These disincentives especially arise because the federal states and municipalities decide about the infrastructure of rescue services, but the costs are primarily borne by the statutory health insurers. For instance, new air rescue stations have been set up in recent years. It is doubtful whether the decisions for setting them up were always driven by demand and capacity utilisation needs.
The Federal Government and the federal states should establish clear rules on the funding of rescue services, especially what the term transport costs comprises. Where statutory health insurers share in the funding of rescue services, they should in future be adequately involved in key organisational management decisions.