Big business representatives defend hospital closures in Germany

By Markus Salzmann
18 April 2020

Although COVID-19 infections continue to spread rapidly in Europe, with thousands becoming ill and dying, big business representatives in Germany are defending the hospital closures of recent decades and preparing new ones. They are playing down or ignore the catastrophic conditions in hospitals and nursing homes.

The economist Professor Boris Augurzky of the Leibnitz Institute for Economic Research (RWI) claimed that there are not currently too few, but too many hospitals in Germany, and called for the crisis to be used in a targeted manner to further reduce the number of facilities. He said he was “sad” that no more hospitals had been closed. “Why should a more efficient hospital structure be worse in a pandemic like the current one,” he asked on the podcast Tonspur Wissen. But efficiency here merely means profitable.

Augurzky calls for the closure of more small hospitals, “greater specialization” and above all greater profitability. “Of course, a small hospital with 100 beds might then no longer exist in the neighbourhood,” the economist says. But this would not mean a reduction in medical staff and the number of intensive care beds, he claims.

That this is not true is obvious. The massive reduction in the number of beds is leading to deficiencies in care in all areas and in personnel. Furthermore, the hospital “in the neighbourhood” is crucial in life-threatening emergencies. Even today, rescue services must sometimes travel great distances to a hospital, which costs lives.

Augurzky also advocates a shorter length of stay in hospitals and a shift towards outpatient care. “Go there in the morning, back in the evening,” he says. In doing so, he is talking about a tightening of the development that began with the introduction of per-case flat rates—so-called Diagnosis-related Groups, DRGs, originally established in the US. These have massively increased the pressure on hospitals to be profitable. He cynically explained that “the impression has been created” that the health care system has been saved, complaining that “more and more is being spent on health.”

The professor speaks for that narrow stratum at the top of society, where every cent that goes into public care is a thorn in their side.

His argumentation is anything but new. Last summer, the Bertelsmann Foundation called for the closure of every second hospital in Germany and suggested that not even 600 of the current 1,400 hospitals survive.

Augurzky previously admitted that the peak of the coronavirus infections in Germany, and thus the strain on the hospitals, has not yet been reached. “However, from April onwards, a huge wave of COVID-19 patients will come to the hospitals. Until then we must activate all reserves,” he told the press last month.

At the same time, he was unimpressed by the blatant lack of protective equipment. “But nobody is properly prepared for such a pandemic,” the medical journal Ärzteblatt quoted him saying. That was not even possible, medical protective equipment on the scale that is now required was not practical in normal operations, he said.

For Augurzky, what is “normal” is that doctors and nurses are pushed to the limits of their ability to cope with stress under impossible conditions and expose themselves to health risks. He disagreed with the moderator's remark that health care workers are usually paid properly. Both doctors and nurses have made “major salary leaps” in recent years, he said on the podcast.

While Augurzky and other representatives of big business advocate using the crisis to push through further cuts, it is becoming increasingly clear that the policies of recent decades of cutbacks and privatization have led to the current crisis.

In fact, hospitals and nursing homes have become corona hotspots due to a lack of personnel and materials. A research group at the London School of Economics has analysed the effects of the coronavirus on nursing homes in Italy, Spain, Ireland, Belgium and France. According to the study, between 42 and 57 per cent of all deaths related to COVID-19 were in these facilities. The extent of the infections and deaths in these homes cannot be ignored, the researchers demand.

News weekly Der Spiegel reports that of the 6,444 patients with lung disease registered by Saturday, 288 had died in Ireland. “156 of them—54 percent—were residents in nursing homes. In Spain, the figure even reached 57 percent. Here, however, the figures were based on media reports on statistics published by regional governments. Belgium came in at 42 percent, France at 45 and Italy at 53 percent,” the news magazine said.

This trend is also evident in Germany. Hamburg’s health senator Cornelia Prüfer-Storcks (Social Democratic Party, SPD) recently had to admit, “We are worried about the nursing homes. Officially, 28 of Hamburg’s 150 or so old people’s homes and nursing homes are now affected, 234 residents are ill and so also are nursing staff.” Due to inadequate testing, the number of cases is certainly much higher.

Peter Walger, a member of the board of the German Society for Hospital Hygiene (DGKH), criticised the negligent conditions in nursing homes and hospitals. In an interview, he answered the question of whether hospitals are adequately supplied in the current corona crisis saying, “No. In the current coronavirus crisis, there is a shortage at every turn, especially in respiratory protection, protective clothing and disinfectants.”

Walger expressly pointed out the danger to personnel and patients. “Where protective masks in particular are lacking, medical personnel are at considerable risk. Staff are normally trained in the wearing of personal protective equipment and their use is well known to all personnel involved.”

“The catastrophe is a result of such shortages and the necessity to improvise in desperation,” Walger explained. According to him, a high number of infected employees in hospitals and nursing homes must continue to be expected. “In the same context, other patients who are not primarily infected with COVID-19 are also infected. What the conditions in hospitals are like cannot yet be substantiated with concrete figures. Initial data from Italy, Spain and China suggest the worst.”

This is also confirmed by a senior physician at a Berlin clinic who recently spoke with the World Socialist Web Site. He noted the serious lack of protective materials. “Face masks, which should actually only be worn for a few hours, have to be used for a week because there are far too few available. We have to sign for them.” According to established hygiene standards, these products should only be used once.

The constant danger of becoming infected increases the pressure on hospital employees. Several doctors and nurses have already died of the virus in the United States and Italy.

Although doctors have had to work overtime even before the coronavirus crisis, this has increased considerably in the last two months. “I regularly work almost 40 percent over the regular 40-hour week without any financial compensation,” the senior physician said. Colleagues have already collapsed under the pressure, breaking down in tears and expressing the sentiment that they are failures. Inexperienced doctors, in particular, were often overwhelmed. “The risk of contracting a potentially fatal disease is a burden on all employees.”

Even before the eruption of coronavirus, beds in the doctor’s ward had already been cut due to a lack of personnel. Now, this shortage was even more dramatic. In order to position a patient being ventilated on their front, for example, four staff must be present for about one hour. “Often there simply is not the staff there.”

Although the risk of infection is so high, far too little was being done to stem the spread of the disease, particularly in hospitals, the doctor complained. For example, there was no basic testing for COVID-19, only when symptoms such as fever or similar occurred. “But by then, it can often be too late.”