Bundestag is due to vote on Germany's emergency care reform on Thursday, 15 October

What the reform would change

The Bundestag is due to debate and vote on the emergency care reform on Thursday, 15 October, with the item scheduled for 9:00 as the first point on the agenda, according to Berliner Zeitung. The black-red coalition of CDU/CSU and SPD is behind the bill, and tagesschau notes it is the third government in a row to attempt an emergency care reform. The aim is to ensure that only patients who genuinely need treatment end up in emergency rooms. Anyone calling 112 or the on-call number 116117 would receive a medical first assessment under uniform criteria, which decides between an ambulance, an on-call practice, a video consultation or a house call. Rescue services would no longer take every patient to any clinic automatically and would treat people at the scene where possible, per NDR.

At or near hospitals, integrated emergency centres (INZ) would bring the emergency room and the statutory on-call service under one roof, with a central front desk deciding whether a patient needs inpatient care. Handelsblatt puts their number at more than 700, while tagesschau cites around 750, and the reports do not explain the gap. Federal health minister Carsten Linnemann (CDU) framed the goal in remarks published by Bild.

Anyone with an emergency should get help quickly.

Doubts from hospitals and doctors

Marc Schreiner, managing director of the Berlin Hospital Association (BKG), expects Berlin to need at least one INZ per district and possibly two in densely populated areas. The BKG counts on 12 to 20 centres across the city, according to Berliner Zeitung. Schreiner welcomes the triage approach but says the reform remains inadequate if office-based doctors cannot secure enough outpatient care.

For Berlin, we expect that there must be at least one INZ per district.

The Kassenärztliche Vereinigung Berlin objects that patients could still decide on their own to go to an emergency room without an assessment. In Lower Saxony, Andreas Hammerschmidt, second chair of the Marburger Bund and a trauma surgeon, argues that phone assessments carry no binding force. NDR reports he fears the law could become a 'zahnloser Tiger', a toothless tiger, that fails to relieve emergency rooms. Large aid and rescue organisations also want improvements, according to tagesschau.

Support and open questions

Janosch Dahmen, a Green health politician who is also an emergency physician, backs many elements of the reform and sees considerable improvements over the current situation. N-tv headlines his assessment with the warning that the reform could come to nothing. Lower Saxony's health minister Andreas Philippi (SPD) calls the bill important and targeted, but says it remains unclear how rescue services will be financed. He also wants the states to have a much stronger say in allocating the INZ.

The draft law contains important and purposeful approaches to this.

NDR reports that the sites of Lower Saxony's INZ are to be fixed within six months, and that the centres should reach 95 percent of the population within 30 minutes.

Costs and expectations

N-tv reports that callers with less acute cases would be forwarded from the emergency line to the on-call service, and that hoped-for savings in the billions are meant to help stabilise statutory health insurance contributions. Experts estimate that around 30 percent of patients do not belong in an emergency room, according to tagesschau. Linnemann places the responsibility on the regulation designed by politicians rather than on patients. Berlin already runs six adult and five children's and adolescents' KV on-call practices next to emergency rooms, according to Berliner Zeitung.