The open letter from District Administrator Dietmar Allgaier:
Dear ladies and gentlemen
The financial situation of hospitals in the state and district of Ludwigsburg is dramatic. That is why I am writing to you today with both great concern and urgency - in the hope that you, as members of state and federal parliament, can have a positive influence on developments.
Figuratively speaking, the hospitals themselves are in intensive care. They have been under massive financial pressure for years. In total, Baden-Württemberg's hospitals will lack more than 1.5 billion euros in 2023 and 2024. The first insolvencies of non-profit hospitals underline the explosive nature of the situation. For 2024, districts that have had to make extensive structural decisions such as closing two or three hospital sites are also expecting deficits in the double-digit million range. Unfortunately, this also applies to our district.
The districts of Baden-Württemberg are severely and directly affected by the underfunding of hospitals, as they are responsible for providing inpatient care. The majority of district hospital operators are already paying high support contributions to the hospitals. For the current year, the districts are expecting support payments of around 790 million euros. At the same time, the districts are less and less able to finance the sharp rise in hospital deficits from the district budgets. Without compensation for the funding gaps and adequate standard funding from the federal and state governments, there is a risk that the hospitals will be transferred to private operators. This would not only contradict the legally guaranteed plurality of operators, but above all jeopardize the security of care for the population.
This gives rise to urgent demands on the federal and state governments. Prior to an urgently needed hospital reform, the financial conditions for a successful reform process would have to be created with the help of a so-called preliminary law. Furthermore, the federal government should present a reliable impact analysis of its reform. The currently planned change in operating cost financing, including reserve financing, does not do justice to the situation in Baden-Württemberg because it does not take into account the structural change that is already well advanced in the state. The districts of Baden-Württemberg are therefore also calling for a permanent increase in hospital remuneration of at least four percent in order to mitigate inflation and wage cost increases. In addition, there is still no legal regulation that takes into account the above-average personnel and material costs in the state in the agreement on the basic hospital price. There is also an urgent need to reverse the cuts (fixed cost regulation) made by the federal government and to ensure reliable funding for future cost increases: All hospitals included in the state's hospital plan have a legal right to funding for their costs.
Although the state of Baden-Württemberg finances more than other federal states in the hospital sector, it has only covered half of the necessary investment funds for years. As a result, a large investment backlog has built up over time. Against this background, a significant increase in investment funding is urgently needed: Individual hospital funding must be increased by at least 250 million euros.
An increase in flat-rate funding is also urgently needed: It has only been raised once in almost 20 years, in 2012, by ten million euros to 160 million euros. This is nowhere near enough to keep pace with cost developments. This has also led to a considerable investment backlog and to the providers having to make advance payments in order to ensure that inpatient care meets demand. The municipal level has therefore rightly been calling for an increase in flat-rate funding of 100 million euros for years. The state is obliged to provide adequate funding for investment costs and must finally fulfill this obligation!
At the same time, an emergency aid programme is urgently needed in order to stabilize the hospitals financially this year. This program should have a minimum volume of 300 million euros.
The federal government bears the main responsibility for the disastrous financial situation of the hospitals due to its inadequate financing of operating costs. Nevertheless, the state cannot and must not hide behind the federal government's legislative competence for financing operating costs, as it has transferred the duty to ensure hospital care to the districts. Therefore, if the federal government does not help and the state alone is the point of contact for the municipalities for all financial constitutional matters, the state must step into the breach and set up the urgently needed emergency aid program.
I ask you to use your influence to bring about the urgently needed changes described above in such an important area of public services as hospital financing. Thank you very much in advance for your commitment.
Yours sincerely
Dietmar Allgaier
