More than half of hospital cases in all 16 German federal states could be avoided or treated on an outpatient basis, according to a new analysis presented on Wednesday in Berlin by the Scientific Institute of the AOK health insurance (WIdO), the "Hospital Report 2026." At the federal level, approximately 8.6 million of the total 15.2 million hospital cases in 2024 would be "amenable to outpatient treatment" or avoidable.
According to the evaluation, around 42 percent of hospital bed occupancy days and 39 percent of clinic expenditures could be saved. The potential for outpatient care is particularly large in internal medicine and general surgery, with over 60 percent of cases in each specialty.
In the individual federal states, the spectrum of so-called outpatient conversion potential ranges from 53 percent in Bremen to 58 percent in Rhineland-Palatinate and North Rhine-Westphalia.
No federal state has yet succeeded in realizing this potential "to a structurally relevant extent," explained WIdO Managing Director and study author David Scheller-Kreinsen. Outpatient care leads to significantly lower costs compared to inpatient care, as the "expensive requirement" of round-the-clock supervision is eliminated.
"The issue is not being addressed consistently with the current hospital reform," Scheller-Kreinsen criticized. "The reform contains practically no measures for outpatient conversion, which is urgently necessary given the shortage of skilled workers and the high costs in the hospital sector." He called for policymakers to make adjustments.
"We must do more to advance so-called outpatient conversion, that is, the shift of inpatient services to the outpatient sector," also demanded Carola Reimann, CEO of the AOK Federal Association. The currently applicable hospital reform will not be able to achieve much on this issue, as initial evaluations show.
The shift of hospital treatments to the outpatient sector is urgently necessary, Reimann emphasized. "Because there, patients can be treated with the same quality at lower costs for the insured community."
The hospital reform, which came into force over a year ago, aims for greater specialization of German clinics. Smaller hospitals in particular should offer fewer services and limit themselves to procedures they master well. At the beginning of March, the Federal Council approved amendments to the reform. These include, among other things, exemption rules for smaller hospitals in rural areas.
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