A sweeping reform package aimed at alleviating pressure on German emergency rooms and ambulance services, while simultaneously generating billions in healthcare savings, is being drafted by Health Minister Nina Warken (CDU), according to reports in the Frankfurter Allgemeine Zeitung. The proposed legislation, slated for review by the cabinet early next year, seeks to address what officials describe as a significant issue: the overuse of emergency facilities.
The core of the proposed overhaul centers on mandatory preliminary medical assessments, conducted either via telephone or in person, to more accurately triage patients and curtail inappropriate utilization of emergency services. While patients will retain the existing option of accessing emergency rooms without an appointment, the draft envisions a faster process for those who first contact the 116117 emergency medical advice hotline and can present proof of that initial assessment upon arrival. The Ministry reportedly intends to prioritize these pre-assessed patients in the treatment queue.
Furthermore, the plan calls for a nationwide rollout of Integrated Emergency Centres (INCs), collaborative facilities linking hospitals and private physicians, operating around the clock. These centers would handle patients based on the urgency of their condition, directing them to either the emergency room, an out-of-hours physician’s practice, or, in non-emergency situations, back to regular healthcare provision.
The government estimates that approximately one-third of current emergency room visits are inappropriate. The proposed digitalization of emergency response systems, linking number 112 and 116117, suggests a unified, nationwide triage process intended to directly route patients to the most appropriate care setting. Calculations within the draft suggest potential annual savings of 1.21 million emergency service interventions and €2.3 billion.
A significant portion of the €225 million annually allocated from a special infrastructure fund will be dedicated to modernizing the digital infrastructure of physicians’ practices, hospitals and ambulance services.
The draft also proposes a structural change for ambulance services, allowing them to bill directly under the Social Security Code Book 5, rather than solely relying on mileage reimbursement. This shift, according to the FAZ, aims to shield patients from potentially high out-of-pocket expenses, which can reach up to €2,000 per deployment under the current system.
Initial projections estimate savings of nearly €300 million in the first year, escalating to over €1 billion annually in the long term. The largest savings are anticipated from redirecting patients from emergency dispatch centers to outpatient care-a potential €700 million annually-followed by efficiencies in ambulance transport and a reduction in physician-staffed emergency responses.
Beyond immediate care, the draft highlights the potential for a further billion euro annual savings by reducing follow-up costs associated with ambulance deployments that ultimately lead to hospital admissions deemed unnecessary. The legislation faces scrutiny for its potential impact on patient access and the feasibility of the proposed triage process, as well as questions around the necessary digital infrastructure to support such a dramatic shift in emergency healthcare delivery.