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Patient transport under pressure: New rules could further burden taxi companies.
For taxi and rental-car companies that regularly transport patients, the coming years are unlikely to become any easier. Industry representatives are particularly critical of how quickly the legislative process was pushed forward. According to associations, the affected stakeholder representatives were given only one day to comment on the government’s plans. An in-depth technical discussion about the practical consequences remained largely absent. This concerns an area that is of substantial economic importance for many companies.
Higher co-payments for patients
For insured individuals, the amount of their own contribution will initially change. Although the basic rule remains that patients must bear ten percent of the costs of a medical transport themselves. From 2027, however, fixed limits will be introduced. The co-payment will then be at least 7.50 euros and at most 15 euros. For patients, this means greater planning certainty. For the companies, however, the real challenge lies elsewhere.
Strict limits on remuneration adjustments
So far, negotiations on the remuneration for patient transport have varied regionally.
In Saxony-Anhalt, cost bearers often based themselves on the so-called Grundlohnsummensteigerungsrate, with the development of the statutory minimum wage also flowing into the negotiations. In Thuringia, in turn, price-escalation clauses ensured that tariff adjustments of the taxi industry were regularly passed on to the remuneration for patient transport.
The new regulation clearly restricts this latitude.
For the years 2027 to 2029, the legislature requires that remuneration adjustments be aligned with the Grundlohnsummensteigerungsrate. Moreover, the increase may even be up to one percentage point below this rate. This has significant practical consequences, since the actual costs of many businesses have for years grown far more dynamically than the Grundlohnsumme.
The gap continues to widen
The taxi and rental car industry is simultaneously contending with rising personnel costs, higher vehicle prices, increasing financing costs and the electrification of fleets. There are also insurance costs, workshop costs, and rising requirements for vehicle technology.
While these costs are rising sharply in many places, reimbursements for patient transport could rise much more slowly in the future.
An example from Thuringia illustrates the problem. Here, the average gross revenue per occupied kilometer for seated patient transports is currently €2.89. With an assumed four percent increase in the gross wage sum, only a three percent adjustment would be possible. The per-kilometer price would thus rise to €2.97.
Similar calculations apply to Saxony-Anhalt. There, the price per kilometer for single patient transports would be €2.53 after a three percent increase, instead of €2.46 previously.
On paper, reimbursements therefore continue to rise. The crucial question, however, is whether they keep pace with actual costs.
Patient transport is already often not very attractive
In many operations, patient transport is already not considered a particularly lucrative business today. Nevertheless, they form an important part of the order volume. Especially in rural areas, they often ensure a certain baseline utilization.
Particularly affected in the future could be companies that perform specialized transports. This includes wheelchair transports, stretcher transports, or trips with lying-down transports. The specialized vehicles required for these incur high capital and operating costs. Industry representatives assume that here as well the guideline "gross wage sum increase rate minus one percent" will be applied consistently in the future.
Thus threatens a development that many entrepreneurs already know from other sectors: revenues rise more slowly than costs.
Greater pressure on negotiations
Against this backdrop, associations advocate a unified industry stance toward the health insurance funds. The argument is understandable: if companies offer services permanently on terms that do not cover costs, the economic problems worsen with every ride.
At the same time, many businesses face a dilemma. Patient transport secures revenue and utilization. Forgoing such contracts can also have significant short-term financial consequences. The coming years are likely to be shaped by difficult negotiations. Health insurance funds will reference the statutory upper limits. Companies will point to their rising costs.
Another issue: The future of mini-jobs
At the same time, the industry is dealing with another topic. The federal government continues to discuss possible changes in marginal employment relationships. The Federal Association of Taxi and Rental Vehicles has launched a survey of entrepreneurs on this subject. (the survey can be accessed here) The aim is to obtain robust data on how important mini-jobs are for taxi and rental car businesses and what consequences a reform would have for the industry.
For this reason as well: what on the political level appears to be a social-policy correction can have significant impacts on personnel planning and profitability in day-to-day operations.
For the taxi and rental car industry, this adds another uncertainty. As costs continue to rise, the room to maneuver with patient transport becomes smaller. The question of how economically these services can be operated in the future is therefore likely to occupy many entrepreneurs even more urgently in the coming months.
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