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VSPV sounds the alarm: patient transport in the crosshairs of austerity policy
In the case of the planned GKV contribution-rate stabilization act, it is § 133 of the Social Code V. Behind the sober designation lies a regulation that could have significant economic consequences for taxi companies, rental car operators and ambulance and patient-transport providers. The Association of Private Commercial Road Passenger Transport in North Rhine-Westphalia (VSPV) is therefore sounding the alarm. Shortly before the planned adoption of the law, the association again addressed members of the Bundestag, health policy politicians and members of the Health Committee. The demand: The proposed changes to the remuneration for patient transports should be removed from the law or at least postponed.
Dispute over cost development
At its core, it is about the question of how much the remuneration for patient transports may increase in the future. Until now, the so-called gross wage-sum change rate has served as a reference for remuneration negotiations between statutory health insurers and service providers. In the future, this indicator is to become, according to the federal government's wishes, a binding upper limit. In the first years, it should even be reduced by another percentage point.
For the health insurance funds, this means a predictable cost development. For the companies, it means rising expenses at the same time as revenues are capped. The VSPV thus regards the planned regulation as economically problematic. Managing Director Sascha Waltemate formulates the criticism deliberately in simple terms:
"A service cannot be purchased in the long run for less than its production cost."
In fact, the cost structures of the industry have changed markedly in recent years. Higher wages, rising vehicle prices, insurance costs, workshop costs and increasing digitalization burden the cost calculations of many businesses. This very development, according to the association's argument, cannot be permanently offset by rigid reimbursement caps.
A small saving with big consequences?
The VSPV has also substantiated its criticism with figures. According to calculations by the association, every percentage point of a smaller remuneration increase saves the statutory health insurers around 20 million euros per year. Measured against the total expenditures of the statutory health insurance, this amount appears modest. The consequences for the service providers could, however, be significantly greater. In the association's view, a scenario looms in which fewer and fewer companies are willing to enter into remuneration agreements with the health insurers. Patient transports would then no longer be organized as in-kind benefits, but more often processed under the reimbursement principle. For patients, little would change at first. They would continue to be transported to dialysis, to radiotherapy or to rehabilitation. The difference would lie in the billing.
Instead of contractually agreed special tariffs, regular taxi tariffs or other market-standard prices would then apply more often. From the VSPV's point of view, this would ultimately not be cheaper for the health insurers nor easier for the insured.
Threat from North Rhine-Westphalia
The association will not settle for warnings. If the planned cap becomes law unchanged, the VSPV has already announced a concrete step. By the end of March 2027, it intends to publicly announce the termination of all framework and remuneration agreements with the statutory health insurance funds in North Rhine-Westphalia by the end of 2027.
It is still only an announcement. However, it clarifies how seriously the industry takes the development. After all, patient transport trips are in many places among the economically important business fields of taxi companies. Especially in rural regions and outside the classic peak demand periods, dialysis, rehabilitation, or regular trips often secure a substantial portion of capacity.
Criticism of the procedure
The dispute is not limited to the contents of the law. The VSPV also criticizes the parliamentary procedure. The trigger is the high speed with which the legislative process is being pushed forward. According to the association, extensive amendment motions were only transmitted to the deputies a few days before the final deliberation. Several opposition factions therefore announced that they would seek constitutional urgent relief. However, the Federal Constitutional Court on July 9 rejected the urgent motions of Bundestag members Janosch Dahmen (Greens) and Ates Gürpinar (Left) against the legislative procedure for the GKV contribution rate stabilization act. Thus the second and third readings planned for July 10 could take place. The Bundestag has subsequently passed the GKV contribution rate stabilization act as intended. With that, the law has been passed by the Bundestag. Now the critics' hopes rest with the Federal Council.
Patrick Meinhardt, the association's general representative and former member of the Bundestag, doubts the procedure.
„Why is such a far-reaching law with significant financial implications for each of us and for the entire taxi industry being stitched together so hastily?“, he asks.
Waltemate also expressed considerable doubts about the procedure:
„This so-called GKV stabilization act is being bulldozed through the Parliament at a frantic pace against the vote of most associations.“
Hope for the emergency reform
From the association’s point of view, an alternative is already on the table. The Federal Council had pointed out that the planned emergency reform would anyway reorganize the entire area of patient transport, patient conveyance and emergency medical services. The states therefore propose treating the regulations on patient transport there and not in the GKV contribution rate stabilization act. For the VSPV this would be the more appropriate path. The matter could then be discussed in connection with the other reforms of the emergency services—and not as a side aspect of an austerity bill.
More than a tariff issue
For outsiders, the debate may sound like a technical dispute over reimbursement formulas. In fact, it is about a fundamental question: How much may the mobility of sick people cost—and who bears the economic risk? The health insurance funds are under significant cost pressure. At the same time, medical transport rides must remain available nationwide. Between these two goals, the political discussion is moving, in which the taxi industry risks being crushed.
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