Health care Hospitals – key information about their duties, differences and how to find a hospital

Hospitals are medical facilities where medical conditions or injuries are diagnosed and treated. Obstetric care and end-of-life care also fall within the remit of hospitals.

Hospitals’ area of responsibility starts at the point where medical practices are no longer able to provide medical care.

Examples of such cases include:

• Treatments that cannot be provided on an outpatient basis
• Certain medical conditions
• Severe injuries
• Emergencies

The main role of a hospital is to provide inpatient treatment. An inpatient stay is deemed to exist once a person has been admitted to a hospital for at least one day and one night. During this period, the hospital provides the patient with guaranteed meals and accommodation.

However, some hospitals also offer outpatient treatment services. In the event of outpatient treatment, people are not admitted to hospital. For example, many specialist departments offer both general consultations and special consultations for certain medical conditions. Certain operations can also be performed on an outpatient basis.

Most hospitals also have emergency departments for emergency care. Emergency departments treat patients in emergencies or if registered doctors are unable to care for them in urgent cases. This can be the case at night or at the weekend, for example.

If a situation is not an emergency, however, the non‑emergency medical assistance service should be the first port of call at night or at the weekend. This can be contacted around the clock from anywhere in Germany by calling 116117.

University hospitals and teaching hospitals also train medical students. Nursing staff are trained in almost all hospitals. Some hospitals furthermore make an important contribution to medical research, for example by conducting studies on new treatment procedures.

In 2023, there were 1,874 hospitals in Germany with a total of 476,924 beds. Hospitals can be classified by size and facilities as well as based on their financing. There are also hospitals that perform special tasks.

What are the different care levels?

The federal states are responsible for hospital planning. They plan how many hospitals are required and rule on their approval. During the hospital planning process, hospitals are primarily divided into the following care levels depending on their size and the number of specialist departments:

• Primary care: primary care hospitals treat medical conditions from the fields of internal medicine and general surgery.
• Standard care: standard care hospitals have additional specialist departments, for example for gynecology and obstetrics or orthopedics.
• Priority care: priority care hospitals cover an even wider spectrum, including specialist departments for areas such as pediatrics and neurology.
• Maximum care: maximum care hospitals offer the widest range of services. They treat even extremely rare or serious diseases.

What is the difference between “approved” hospitals and private hospitals?

Federal states decide which hospitals are included in a “hospital plan”. These hospitals are then approved, entitling them to provide medical care to people with statutory health insurance at the expense of statutory health insurance providers. Purely private hospitals, on the other hand, only treat private or self-funded patients. The respective contracts and tariffs stipulate which supplementary services are covered by private health insurance providers. 

Statutory health insurance only covers the cost of treatment in non‑approved private hospitals on exceptions and only up to a maximum of the amount the treatment would have cost in an approved hospital. Whether and to what extent treatment costs are covered by statutory health insurance must be determined in advance on a case-by-case basis.

What hospitals are there with different specialisms?

In addition to general hospitals, there are also hospitals whose activities are organized in a special way. These include the following:

• University hospitals: these hospitals not only provide patient care but also conduct research and provide teaching and medical training. University hospitals usually employ specialists from all medical disciplines. As a result, they are also able to treat particularly serious and complicated medical conditions.  
• Specialist hospitals: these hospitals have specialized in certain disciplines. Examples of specialist hospitals include pediatric hospitals, pulmonary hospitals or psychiatric hospitals.
• Non-resident doctor hospital (Belegkliniken): in these hospitals, patients are treated by doctors who are not employed by the hospital but usually have a practice elsewhere. The hospital provides patients with accommodation, meals and care.
• Day hospitals and night hospitals: these hospitals provide semi-residential care. For example, people with certain mental disorders only require care at night. On the other hand, certain treatments, for example some forms of chemotherapy, can be provided in day hospitals. Patients then return home at night. 

Hospital operators are referred to as hospital owners.
There are three types of hospital owners in Germany:

• Public owners
• Non-profit owners
• Private owners

Examples of public owners include federal states, municipalities and social insurance agencies such as employers’ liability associations. Although public owners operate less than a third of all hospitals in Germany, they provide almost half of all hospital beds. They are often large maximum care hospitals, including university hospitals.

Examples of non-profit owners include ecclesiastical business groups and social and humanitarian associations, such as the German Red Cross. The owners do not aim to make any profits from operating the hospitals.

Private hospital owners, on the other hand, aim to make a profit from operating hospitals. Both individual companies and company groups can act as private owners. Private owners operate the largest number of hospitals but the smallest number of hospital beds. These are often special hospitals.

If hospitals are included in a state’s hospital plan, they are financed in two ways. 

• Investment costs are borne by the federal state. These include the costs of renovation measures or procuring large medical equipment, for example.
• The “cost bearers” bear the costs of the patient care. These include statutory health insurance providers and private health insurance companies. Hospitals usually settle the cost through the use of flat-rate fees. Depending on a patient’s medical condition, hospitals receive a flat-rate payment. This is based on the standard treatment and treatment duration of a typical patient with the same diagnosis. The flat rate may be higher or lower depending on the type and severity of the condition. Individual factors such as secondary diagnoses, complications or the patient’s age can also affect the amount the hospital receives.

The flat-rate fees relate to medically required services. In some cases, however, patients may also avail of optional services. The costs of these optional services are not covered by statutory health insurance. 

In the event of a planned hospital stay, your doctor will issue a referral letter. This often includes suggestions of suitable hospitals nearby. However, these suggestions are not binding. You have the right to choose the hospital for any planned treatments. If you have statutory health insurance, you can receive treatment in any hospital that has been approved to treat people with statutory health insurance. The only costs not generally covered by statutory health insurance providers are those incurred in non-approved private hospitals. Private hospitals are also allowed to treat people with statutory insurance in emergencies.

Several criteria play a role when selecting a hospital: Firstly, the hospital should be able to properly treat the medical condition in question. This means that it should have specialist departments with sufficient experience in treating the condition. The choice of hospital also depends on personal criteria.

Examples of such criteria include:

• the proximity to the patient’s home
• the availability of foreign language support
• the accessibility of the hospital

All of this information can be found in hospitals’ quality reports. These reports must be published annually by all hospitals and comprise three sections:

The first section provides general information about the hospital, including details of the following:

• Number of beds
• Owner
• Personnel
• Special information relating to equipment
• Additional services
• Accessibility

The second section contains information about the following:

• The specialist departments available
• The services offered
• The qualifications of the specialists
• The number of procedures performed in each department

The third section deals with information on the quality of the services provided by the hospital. This is assessed based on quality criteria defined by the Joint Federal Committee (Gemeinsamer Bundesausschuss). Such quality criteria include the length of time between the detection of a medical condition and the start of treatment. If a hospital fulfills these criteria, it will not receive a bad rating. This section also provides information about the frequency of certain complications in relation to certain services.

The quality reports can be found on hospital websites or in the reference database provided by the Joint Federal Committee.

The Bundes-Klinik-Atlas hospital directory also helps to objectively assess inpatient treatments in hospitals by providing billing data and quality information in a fully accessible and easy-to-understand manner. This makes it possible to compare hospitals.