Berlin – German hospitals are grappling with a severe financial crisis, with a significant number facing potential insolvency. In response, the Deutsche Krankenhausgesellschaft (DKG), the German Hospital Federation, is advocating for increased patient co-payments and new fees for emergency room visits to alleviate the strain on the healthcare system. The proposals, unveiled in recent weeks, have sparked debate about access to care and the future of hospital funding in Germany.
According to DKG CEO Dr. Gerald Gaß, approximately 80 percent of German hospitals are currently operating at a loss. A staggering one-third are threatened with insolvency, with 16 percent considered to be at high risk and another 21 percent facing significant financial challenges. This precarious situation is prompting the DKG to seek immediate solutions, including adjustments to how patients contribute to the cost of their care.
The core proposal centers around increasing the daily co-payment for hospital stays. Currently set at 10 euros per day – a figure that hasn’t been adjusted since 2004 – the DKG suggests raising it to 15 euros. Gaß argues that this increase is justified, considering the rise in costs over the past two decades and the fact that hospital patients receive full board during their stay. He likewise emphasized that safeguards are in place to protect patients from excessive financial burden, with a maximum of 28 days of co-payments per year.
Beyond increasing co-payments for standard hospital stays, the DKG is also pushing for a new fee for patients who utilize emergency rooms without a prior medical assessment. The proposed fee would range from 30 to 40 euros, aiming to discourage non-emergency visits and alleviate pressure on already overburdened emergency departments. This proposal is closely linked to the planned emergency care reform expected to take effect in 2026.
The financial woes of German hospitals are not solely attributed to increased patient demand or rising operational costs. Achim Brötel, President of the German County Association, highlighted the particular vulnerability of hospitals operated by charitable and religious organizations, as well as municipal hospitals. These institutions are struggling to secure adequate financial support from their respective governing bodies, exacerbating their financial difficulties.
The DKG is also urging the federal government to extend a temporary financial aid package of four billion euros, which was initially implemented in November 2025 to stabilize the hospital system. This aid is crucial, according to Gaß, to prevent further deterioration of the financial situation and ensure continued access to quality healthcare for all Germans.
Dr. Gaß’s position as head of the DKG has recently been reaffirmed, with the organization’s presidium voting to extend his term early, a decision made on March 10, 2025. This move, according to the DKG president Ingo Morell, signals a commitment to continuity during a period of significant upheaval and challenges for the German hospital landscape. Morell stated that the DKG aims to continue constructively shaping the future of hospital care in Germany, building on the progress made in recent years despite challenging political conditions.
The proposals from the DKG come amidst broader discussions about the sustainability of the German healthcare system. In late December 2025, Dr. Gaß also suggested doubling hospital co-payments as a means of easing the financial burden on health insurance funds, a move that underscores the urgency of finding solutions to the growing financial pressures facing the sector. The German healthcare system, facing a deficit of around six billion euros in 2024, is clearly in need of reform.
The situation is complex, and the proposed solutions are likely to face scrutiny from patient advocacy groups and political stakeholders. The debate over how to fund German hospitals is far from over, but the DKG’s proposals represent a significant step towards addressing the looming financial crisis and ensuring the long-term viability of the healthcare system.
Looking ahead, the German Bundestag recently paved the way for more stable hospital finances, a move welcomed by the DKG. The next key development will be the implementation of the emergency care reform in 2026, and the decision regarding the extension of the four billion euro federal aid package. These developments will be critical in determining the future of German hospitals and the quality of care they can provide.
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