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Heidelberg/Mannheim – The Federal Cartel Office has prohibited a merger between the university hospitals in Heidelberg and Mannheim. After months of investigation, the authority came to the conclusion that the expected disadvantages, especially for patients, outweigh the possible advantages.

The state of Baden-Württemberg now wants to apply to the Federal Ministry of Economics for a so-called ministerial permit in order to ensure that, in addition to market dominance, aspects such as the need for health care, cutting-edge research or urgently needed medical study places are taken into account.

The state of Baden-Württemberg and the city of Mannheim are striving to combine the hospitals in order to preserve the highly loss-making Mannheim location – and to create a “European lighthouse project for medicine”, as Mannheim’s former mayor Peter Kurz (SPD) put it last year. The state is responsible for the Heidelberg location, the city of Mannheim is responsible for the local university hospital.

“We remain convinced of the necessity and importance of the merger desired by all parties involved – from an economic and medical-strategic point of view and especially because of the social responsibility for the best possible care for patients,” explained Science Minister Petra Olschowski (Greens).

Antitrust law is not designed to take into account the special features and challenges of a merger between two such large university hospitals, bearing in mind that if the merger is prohibited, cutting-edge medical research, high-quality patient care and around 270 medical study places could be lost.

In the desired association, both hospitals should work closely together on a medical, economic and scientific level without losing their independent profile. In Mannheim alone, there are a total of 2,000 places to study human medicine. The plan was for Heidelberg University Hospital to become the majority shareholder in Mannheim University Hospital.

The President of the Federal Cartel Office, Andreas Mundt, explained that the competitive disadvantages resulting from a merger would primarily be borne by patients, “because apart from the clinics of the parties involved, there are only a few comparable and independent competitors in the region, and in some medical fields almost none at all.”

If major providers belong to the same carrier, quality competition would be lost because there would no longer be the same level of fear of customers switching to competitors, the authority argues, among other things.

According to Mundt, the Federal Cartel Office also took into account an argument put forward by the parties that size, higher case numbers and specialization often lead to better quality of treatment. “However, we do not assume that the merger is necessary at all to achieve this advantage. Other forms of cooperation can have similarly positive effects without depriving the clinics of their independence.”

The Federal Cartel Office analyzed the range of services and patient origins of more than 320 hospitals within a radius of around 150 kilometers around Heidelberg and surveyed 30 hospitals and 215 practicing specialists in the region. The decision is not yet legally binding. An appeal can be filed against it with the Düsseldorf Higher Regional Court.

According to Health Minister Manne Lucha (Greens), the proposed network is still the right path to ensuring needs-based, high-quality healthcare in the entire Rhine-Neckar region. “I therefore support the now necessary path of submitting an application to the Federal Ministry of Economics to achieve these goals.”

The University Hospital in Mannheim is making high losses – so high that the state has had to spend large amounts of money on support since 2021. According to the city, the hospital expects a loss of 99 million euros for 2025.

“The financing of a supramaximal care provider that provides patients not only from the region but from all over Germany with highly specialized medical services based on scientific excellence is increasingly pushing our city to the limits of its financial capacity,” said Mayor Christian Specht (CDU).

According to previous information, Heidelberg University Hospital has almost 2,600 beds and a good 86,000 inpatients and more than a million outpatients per year. With 10,700 employees, it is one of the most important employers in the region. Around 4,300 employees work in the Mannheim hospital. They treat almost 45,000 inpatients and over 170,000 outpatients. © dpa/aerzteblatt.de