“Networked, outpatient, AI-supported: How Germany’s clinics see their future,” is the title of the management consultancy Roland Berger’s report by Dr. med. Peter Magunia and Janes Grotelüschen, senior partners and partners at Roland Berger, prepared the 2023 hospital study (1). For the current edition of the study, managing directors and medical directors of the 600 largest clinics in Germany were surveyed, with the participants representing the entire spectrum of the clinic landscape based on sales, number of employees, number of beds, sponsorship and the various levels of care. What is particularly clear is that, despite continued deterioration in profitability, many people in charge have recognized the signs of the times and are now in the process of reorienting their companies to be more outpatient and technology-driven.

>> As in previous years, the study into the condition of German hospitals provides current figures on their economic situation. And once again it becomes clear: According to those surveyed, profitability has continued to deteriorate in most cases. In addition, there are uncertainties in financing, challenges caused by the shortage of skilled workers and declines in inpatient services, which are putting further strain on hospitals. Nevertheless, according to the two study authors, there is a noticeable trend reversal in the assessment of the economic prospects, as many hospitals are in the process of realigning themselves and preparing for a future in a significantly changed competitive environment in a much more outpatient and technology-driven manner.
The starting position is rather difficult because, according to the study, the clinics' annual results have only been heading in one direction for years: further and further into the red. Little has changed in this regard in the past year, 2022. In last year's study, around a third of the participants reported a loss for their houses in 2021, but in 2022 the proportion has already risen to more than half (51%). Publicly run clinics were particularly hard hit, with 63%. And across all providers, only just under one in four clinics achieved a positive annual result last year.
According to those surveyed, the precarious economic situation affects small, medium-sized and large hospitals equally. However, compared to 2021, the majority of small houses also recorded a deficit for the first time. According to the study, the most important causes for the tense financial situation include the lack of personnel, especially among nursing staff, as well as uncertainties in financing, rising prices due to inflation and an increasing investment backlog in many facilities.
Naturally, the planned hospital reform is currently one of the top topics in the industry. Accordingly, this topic was also included in the Roland Berger survey by asking participants to assess the impact of the reform at the beginning of May - at a time when the general political direction was known, but no details were yet available (see MVF 03 and 04/23). It became clear that the expectations of those responsible with regard to short-term relief are not particularly great. Only three percent expect their hospital's economic situation to improve by 2024 as a result of the hospital reform. According to the cumulative information provided by those surveyed, the short and medium-term forecasts are significantly more pessimistic, especially for smaller institutions. According to the study, those responsible only expect relief effects from the structural change in the hospital landscape from 2028, but also from efficiency gains as a result of digitalization, for example through digital patient files, e-prescriptions or the increased use of telemedicine services.
From the perspective of those surveyed, one consequence of years of negative development is unavoidable: the number of clinics in Germany will fall significantly. While there were just under 1,900 hospitals in 2021, 51% of the participants expect a maximum number of 1,250 by 2033. This represents a decline of minus 34%. Accordingly, every third clinic would close. According to the study results, 13% of the experts still expect the hospital landscape to be reduced to fewer than 1,000 hospitals. This would then be a decline of minus 47% - in effect the end for almost every second hospital.
However, according to those surveyed, the greatest decline is not expected until 2028 to 2033. The main reason for the forecast reduction is the increasing outpatientization, the shift from services previously provided in inpatient care to increasingly outpatient care. “The outpatientization of the healthcare system represents a transformative change and requires a fundamental rethinking of existing structures,” explains co-author Grotelüschen. Hospitals would now have to realign their resources, while the health system would have to completely reorganize. “The upcoming structural change is a great opportunity because it opens up significant opportunities for German hospitals to provide future-proof healthcare and paves the way for networked and innovative medical care, writes Dr. med. Peter Magunia, Senior Partner at Roland Berger, in his accompanying text on the recommendations for action that the management consultancy believes are now important for managers. According to the Roland Berger study, these are three main points:
1. Keep an eye on the important issues: Service providers will face major challenges in the coming years: While they must ensure short-term economic stability and address trends such as outpatient care, AI or the shortage of skilled workers in a structured manner, they must not neglect long-term goals such as digitalization . All aspects must be kept in mind equally.
2. Avoid conflicting goals: Some trends in the German healthcare system are currently difficult to reconcile. An improved work-life balance for employees is unlikely to be accompanied by increasing hospital performance in the short term. Potential conflicting objectives must therefore be meaningfully taken into account when evaluating trends and deriving measures.
3. Define strategic position in the ecosystem: Mergers could be a sensible further option for houses. For all hospitals, the aim should be to develop a strategic positioning within an ecosystem of networked healthcare providers. <<