When saving becomes expensive – Why the new GKV Stabilization Act puts pressure on medical transports.

Sometimes the future of an industry is decided not on the street, but in committees of the Bundestag. For what at first glance seems like a financial-policy reform of the health care system could become an economic stress test for many patient-transport companies. The federal government pursues with the law a comprehensible goal. The statutory health insurance system is under substantial financial pressure. According to the Federal Ministry of Health, the expenditures of the health insurance funds have been rising for years significantly faster than their revenues.

The reform is therefore intended to curb the expenditure dynamics and stabilize the contribution rates. In the future, pay increases in almost all areas of the health care system are fundamentally to be linked to the development of the so-called gross wage sum. In the years 2027 to 2029, this value should be reduced by a further percentage point. What, from the perspective of health policy, appears to be a savings measure, raises serious concerns among providers of patient transport.

“Silent pillar” of the health system

Patient transports belong to the invisible services of the health care system. Dialysis patients, people in radiotherapy, seniors on their way to outpatient treatment or patients after operations – millions of people rely on reliable transport every year. According to the industry associations, taxi and ride-service companies nationwide carry out around 50 million patient transports annually. For many businesses, they have now become a substantial part of their revenue. Especially in rural regions, patient transports often form the economic basis for maintaining regular taxi operations.

The problem: The remuneration for these trips is not freely negotiated on the market. The basis consists of contracts with the health insurance funds under § 133 SGB V. Already today many companies complain that the agreed remuneration is often only barely cost-covering.

This is exactly where the criticism of the draft bill begins.

Costs rise faster than the reimbursement

The past few years have placed a heavy burden on the industry. Higher fuel prices, rising insurance premiums, new requirements for vehicles, digitalisation costs and, above all, the substantial increases in the minimum wage have changed the cost structure of many companies.

While numerous businesses report cost increases in the double-digit percentage range, the adjustment of the remuneration is to be significantly limited in the future. The planned linkage to the gross wage sum practically means that price increases will often remain below the actual cost development. For the companies this creates a gap between costs and revenues. Because if patient transport cannot continually be delivered cost-effectively, businesses will reduce their offerings or exit this segment altogether.

Austerity law with side effects

Interestingly, not only taxi and rental-car associations warn about the consequences of the reform. Physician associations, hospitals and other providers also criticize the planned remuneration caps. The accusation is uniformly similar: The alignment to the gross wage sum does not adequately reflect the actual cost developments.

This would have a particular consequence for patient transport.

Taxi companies are among the most cost-efficient providers in the health system. If this offering disappears, the transport needs do not disappear. Patients still need to reach treatments. The alternative would often be ambulances or other forms of medical transport. However, these incur substantially higher costs than a taxi or rental-car ride. And this is precisely the paradox of the current debate. A measure intended to limit short-term expenditures could, in the long run, cause higher costs.

Taxi associations formulate it starkly: Those who economically pressure the cheapest providers risk eventually a more expensive overall care chain.

The call for a sense of proportion

Notably, the industry presents itself unusually united on this question. Taxi, rental-car and patient-transport associations have for the first time presented a common position.