Hospital.Help

Bonn – The federal states have been able to receive funding for the restructuring of the hospital landscape and the restructuring of clinics with funds from the hospital structure fund since 2016. However, the latest data shows that many funds have not yet been accessed. There are currently more than one billion euros available, according to the Federal Office for Social Security (BAS) when asked German doctors­leaf explained.

According to the authority, the federal states still have around 1.16 billion euros available for their own state projects and 94.4 million euros for cross-state projects. The funds must be applied for by December 31, 2024. The funding from the hospital structural fund is intended to contribute to improving the structures in hospital care. The available funds have been repeatedly increased through various laws since 2016. Up to two billion euros are planned by the end of 2024.

As of May 6, 2024, the federal states have applied for funding totaling 807.8 million euros for state-specific projects and 5.4 million euros for cross-state projects, the BAS explained. The 5.4 million euros have already been paid out in full. 663.8 million euros went to the state’s own projects.

As part of the planned hospital reform, the federal states had repeatedly called for faster disbursement of the planned transformation fund, which is intended to support restructuring in the hospital sector. However, the BAS figures show that there are still many resources available in the hospital structural fund for similar restructuring.

The BAS explained that so little money has only been called up because the states may have focused on the subsequent hospital future fund. This includes a funding volume of up to 4.3 billion euros and should primarily enable an improvement in the digital infrastructure. The federal states had to apply for corresponding funding projects by December 31, 2021.

“This is supported by the fact that the number of applications for the hospital structural fund has recently increased,” the BAS spokesman continued. In addition, the states must coordinate corresponding applications with the cost bearers, i.e. the health insurance companies, and contribute at least 50 percent of the funding from the structural funds.

It is interesting that some federal states have not yet submitted any or hardly any applications regarding the structural funds. Thuringia, for example, has not yet submitted an application. Due to the distribution of the Königstein Key, 50.8 million euros are available for state-owned projects in Thuringia.

This is primarily due to the objectives of the Hospital Structure Act (KHSG) of December 2015, which forms the basis for the fund, where proof of the reduction in inpatient care capacities is determined as a crucial approval requirement for the main part of the funding, writes a spokeswoman for the hospital Ministry of Health Thuringia. “These factors make it considerably more difficult to develop eligible projects in Thuringia and ultimately to submit applications to the federal government.”

Structural changes have already been made

In Thuringia there were already major structural changes in hospital care around the turn of the millennium. The result was a needs-based and high-quality inpatient care offering for the population.

It is therefore difficult for the hospital authorities to define projects that meet the requirements of the structural funds, unlike in other federal states, for example, which carry out processes such as the above-mentioned restructuring of the hospital landscape with the help of the KHSG, according to Thuringia.

The spokeswoman announced that the Structural Fund funding for the conversion of emergency rooms, for example the establishment of integrated emergency centers (INZ) and the establishment/expansion of nursing schools at hospitals, will likely be submitted by Thuringia by the first half of 2024. Thuringia also submitted many applications to the Hospital Future Fund; there was a greater need for structural measures here.

Rhineland-Palatinate has also hardly submitted any applications; up to 91.7 million euros are available to the state. The country will submit corresponding applications by the end of 2024 and exhaust the funding available, said a spokesman for the local Ministry of Health.

NRW: Concentration projects and KRITIS applications planned

North Rhine-Westphalia (NRW) has also only applied for around 23 percent of its available share so far. 400.9 million euros are available for the western German state. In North Rhine-Westphalia there are many metropolitan areas with an excess of inpatient care as well as rural regions in which comprehensive care is sometimes difficult. However, NRW wants to use almost all of the federal funds available, according to the Ministry of Health in Düsseldorf.

“According to the current status, a total of six concentration projects and 27 KRITIS applications (for adapting the information technology of hospitals that are part of the critical infrastructure) are being pursued for funding from the structural funds,” explained a press spokeswoman. Applications have been submitted for four concentration projects, the rest are still in preparation.

NRW also explains the delay with the requirement that the hospital authorities must submit extensive and concrete planning documents for planned construction projects. “In addition, due to the increased construction price index, changes to the plans have become necessary for some projects. For this reason, preparing the applications for submission to the Federal Office for Social Security takes a lot of time,” said the spokeswoman from North Rhine-Westphalia.

Berlin has also hardly applied for any funding so far. However, the city state is entitled to 96.6 million euros. The Senate is currently examining five measures that should be submitted to the BAS by the end of 2024, said a spokesman for the Senate Department of Health in Berlin.

However, only state funds of 49.3 million euros are earmarked for the 2024/2025 double budget for the required co-financing until 2027, the spokesman explained. This means that Berlin will probably only be able to access half of the federal funds.

Projects must be implemented promptly

A special case also occurred in Schleswig-Holstein. The entire funding amount of 64.8 million euros has already been applied for, but has been transferred back, according to an overview from the BAS German medical journal is present.

“At the end of 2023, Schleswig-Holstein withdrew the application – which had already been approved – because the planned implementation deadlines for the planned major project to merge Diako Hospital Flensburg and St. Franziskus Hospital Flensburg were too tight,” explained a spokesman for the Ministry of Health in Kiel.

A new schedule has been agreed with the BAS and the funds remain reserved for the state. Schleswig-Holstein is therefore planning to submit another application for the large merger project in Flensburg.

The hospital structure fund in accordance with Section 12a of the Hospital Financing Act (KHG) has existed since January 1, 2016. It initially served primarily to reduce excess capacity, to concentrate inpatient care offerings and locations, and to convert hospitals into non-acute inpatient local care facilities.

A total of two billion euros in funds are available until December 31, 2024. Around 99 percent of these come from the health fund’s liquidity reserve, the remaining funds are provided by the agricultural health insurance company.

The federal states are eligible to apply. 95 percent of the funds are earmarked for projects in the respective countries, five percent for cross-border restructuring. The funds are distributed according to the Königstein key as of October 1, 2018.

The prerequisite for funding is that the applicant countries, possibly together with the institution to be funded, contribute at least 50 percent of the eligible costs to the project. The BAS is responsible for examining the states’ applications for disbursement of funding from the structural funds and allocating the funds. © cmk/aerzteblatt.de