The challenges regarding outpatient care in Germany could not be greater. With an eye on the possible reappointment of the Federal Ministry of Health under a CDU-led federal government, we are dedicating ourselves to the cultural framework of future outpatient care. Therefore, we are initiating a first cycle of consultations with the working title 'Future Practice Act.'
Campaign for the Future of Outpatient Care in Germany
Outpatient care in Germany, with its approximately 168,000 doctors, 15,500 nursing services, and around 730 million annual treatment cases, is a key pillar of the healthcare system. Despite rising patient numbers and proven resilience during the pandemic, the sector faces significant structural and financial challenges. The trend towards more employment and part-time work, as well as the unequal regional distribution of medical care, requires adjusted health policy strategies. Ensuring sustainable financing and attractive conditions for the outpatient sector remains a central task to maintain high-level medical care for the population in the future.
1.8 million
Funding gap nationwide
Method
Zukunftsdenken
What is Causal Layered Analysis?
Causal Layered Analysis (CLA) is a method of future studies that analyzes complex phenomena through various levels of depth and meaning. Developed by Sohail Inayatullah, it allows us to look beyond the superficial symptoms and understand the deeper structures, worldviews, and narratives that shape our perception of the present and future.
Unlike many traditional analytical methods that focus on visible data and short-term solutions, the CLA guides us through different layers of understanding - from the surface to the deepest cultural foundations.
Be sure to read how we incorporate Causal Layered Analysis in the approach for Cultural Strategic Foresight.
Fundamentally
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The value proposition for events will henceforth focus on upselling, with the possibility of expanding each topic with a mandate. Participation is always free of charge (freemium). Upon registration, one can choose whether to discuss extended support with me. Additionally, there should be an indication of who would find the event interesting.
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I am Frank Stratmann – an experienced foresight and communication designer who works with passion for healthcare professionals. Also known as @betablogr.
Figures and Facts about Outpatient Care in Germany
Outpatient care forms the backbone of the German healthcare system with an impressive reach and capacity. The available data highlight the significance of this sector through comprehensive statistical indicators that document its development, structure, and performance. In recent years, the outpatient sector has seen a remarkable increase in both treatment cases and the number of practicing doctors, alongside a trend towards more flexible working models.
Extent of Outpatient Treatments and Patient Contacts
The outpatient medical care in Germany reaches an extraordinarily large portion of the population. In 2022, around 79.3 million people in Germany were treated on an outpatient basis by doctors, which corresponds to nearly the entire population. These treatments summed up to an impressive 728.5 million outpatient treatment cases in the same year1. These numbers underscore the central role of outpatient care in the German healthcare system.
Outpatient care is characterized by an enormous contact density. Over the course of a year, general practitioners, specialists, and psychotherapists in their practices have around one billion contacts with their patients3. The data from the Federal Statistical Office show that in 2022, with almost 578 million statutory health insurance medical cases, even more was achieved than before the pandemic8. These figures impressively demonstrate the performance and importance of outpatient care structures.
Medical Resources in Outpatient Care
The personnel resources in the outpatient sector have significantly strengthened over the last few decades. In 2023, a total of 168,285 doctors were working in the outpatient sector, an increase of around 28 percent compared to 2002 (131,329)5. These outpatient doctors constitute a substantial portion of the total medical workforce. Of the total 428,474 doctors in Germany in 2023, 39.3 percent belong to the outpatient sector, while 51.8 percent are employed in hospitals5.
The doctor density in Germany has more than doubled since the 1980s, amounting to an average of one doctor for 198 residents in 2022. However, there are significant regional differences: While in Hamburg a doctor looks after around 127 residents, a doctor in Brandenburg takes care of about 246 residents5. This discrepancy highlights the challenges in equally distributing medical resources between urban and rural regions.
Changes in Employment Structures in the Outpatient Sector
The employment forms in the outpatient sector are undergoing significant changes. The vast majority of practicing doctors and psychotherapists are still "classically" working in their own practice, which was true for 124,653 people in 20237. However, more and more doctors are choosing more flexible working forms: In 2023, for the first time, more than 50,000 opted for employment instead of self-employment, and more than 60,000 for part-time work. Since 2013, part-time employment has even recorded an increase of 235 percent, while the number of employments has doubled in the same period7.
Outpatient Nursing Services and Specialized Care Offers
In addition to medical care, the outpatient sector also includes a wide range of nursing services. In 2023, there were 15,549 outpatient nursing services in Germany, documenting a continuous increase since 2009 (12,026)4. This development demonstrates the growing need for outpatient care in an aging society.
In the field of palliative care, there are around 1,500 outpatient hospice services in Germany, of which about 230 are specifically for children and adolescents. This offer is complemented by 403 teams of Specialized Outpatient Palliative Care (SAPV), 36 of which specialize in the care of children and adolescents6. These figures highlight the increasing importance of outpatient care offers also in specialized medical areas.
Resilient Structures During the Pandemic
The outpatient care structure proved to be particularly resilient during the COVID-19 pandemic. While the number of cases in hospitals dropped by more than 13 percent with the onset of the pandemic in the spring of 2020 and remained at this level until the end of 2022, the pandemic-related decline in the 70,000 general and specialist practices was significantly less at just over three percent8. These figures demonstrate the stability and adaptability of the outpatient sector even under crisis conditions.
Financial Challenges in the Outpatient Sector
Despite the growing importance of outpatient care, the sector faces significant financial challenges. According to calculations by the Central Institute for Statutory Health Care (Zi), there is a financing gap of at least 1.8 billion euros in outpatient medical care8. While expenditure on outpatient care rose by only 7.9 percent between 2019 and 2022, and even by just 1.1 percent in the first three quarters of 2023 – values which are well below the inflation rate – real savings are being made in outpatient care for the 74 million statutorily insured patients8.
Conclusion on Outpatient Care in Germany
Outpatient care in Germany, with its approximately 168,000 doctors, 15,500 nursing services, and about 730 million annual treatment cases, represents a pillar of the healthcare system. Despite increasing patient numbers and proven resilience during the pandemic, the sector faces significant structural and financial challenges. The trend towards more employment and part-time work, as well as the unequal regional distribution of medical care, requires adjusted health policy strategies. Ensuring sustainable financing and attractive framework conditions for the outpatient sector remains a central task in order to continue providing high-quality medical care for the population in the future.