How can I own a private hospital

Who pays what in the hospital?

General hospital services

General hospital services are the treatments necessary for the illness that the hospital can provide with the existing equipment (Section 2 Hospital Remuneration Act - KHEntgG). Head physician treatment and single rooms are general hospital services if they are medically necessary.

The fees for general hospital services are approved by the state at licensed hospitals and are the same for all patients (also privately or not insured). Only approved hospitals are entitled to treat those with statutory health insurance.

General hospital services are predominantly remunerated with a flat rate per case. The flat rates are the same regardless of the duration of the treatment in individual cases. For example, hospitals receive a fixed amount of money for treating a patient with a stroke, regardless of whether they are discharged after four or 24 days.

Co-payment

Statutory insurance patients aged 18 and over pay the health insurance company ten euros per day for a maximum of 28 days of stay per year (Section 39 SGB V, Section 39 SGB V). The hospital settles the additional payment directly with the legally insured.

For civil servants, the additional payment is deducted from the allowance.

There is no additional payment for self-payers and those with private insurance.

Elective service chief physician

An optional service that is often used is treatment by the chief physician. The patient has to pay for this service himself. Statutory insurance can take out additional private insurance. Private insurances regularly include these benefits. In the case of civil servants, the aid office reimburses the optional benefits on a pro-rata basis, but deducts a substantial contribution from it.

With the optional “chief physician” service, the patient agrees to be treated by the chief physician, even if this is not medically necessary. The agreement cannot be limited to a single doctor, but includes all doctors involved in the treatment. As a rule, it is agreed that instead of the chief physician, his or her deputy may also treat.

Optional service room

A patient can choose to stay in a single room in the hospital. In hospitals where twin rooms are not standard, they can also be offered as an optional service. These optional services must be agreed in writing between the person concerned and the hospital. The patient has to pay for these services himself.

Statutory insurance can take out additional private insurance. Private health insurances regularly include these benefits. In the case of civil servants, the subsidy office also reimburses the optional services proportionately up to the amount of the cost of a two-bed room, but deducts a substantial contribution from this.

Special comfort services such as telephone, television, internet connection and magazines are usually not included. The patient has to pay for this himself.

Statutory insurance

In particular, workers, salaried employees, trainees and pensioners (§5 SGB V) as well as their non-working family members (§10 SGB V) are subject to statutory health insurance. Under certain conditions, people who are not subject to compulsory insurance can voluntarily join the statutory health insurance scheme (Section 9 SGB V).

The health insurance fund basically offers its insured so-called benefits in kind. This means that the health insurance company bills the hospital directly. The patient only pays the additional payment that the hospital forwards to the statutory health insurance.

Statutory insurance with additional private insurance

Private supplementary insurance covers costs for optional services such as head physician treatment and single rooms to the agreed extent. The insured take it out with a private health insurance company.

Privately insured

People who are not legally obliged to take out insurance (in particular employees whose income exceeds the mandatory insurance limit, self-employed and civil servants, self-employed and civil servants) must take out private insurance. The scope of the reimbursable costs is based on the respective insurance contract, which is based on Section 193, Paragraph 3, Clause 1 of the Insurance Contract Act - VVG and on the model conditions of the Association of Private Health Insurance.

In contrast to statutory health insurance, the cost reimbursement principle applies to private health insurance. This means that the patient pays the hospital bill and is reimbursed the corresponding amount by his or her health insurance company. In the case of privately insured persons, hospitals often forego direct payment by the treated and instead allow the claim to be assigned to the insurance company.

Civil servants

Civil servants receive state aid towards medical expenses. The aid share is regularly 50 percent. For family members and children, higher rates of 70 and 80 percent apply. For the remaining part, they have to take out private insurance.

The cost reimbursement principle also applies to aid. Civil servants pay the hospital's bill and get the corresponding amounts reimbursed proportionally from the allowance and their private health insurance.

In contrast to those who are exclusively privately insured, hospitals hardly forego direct payment to the patient due to billing problems that arise from a split invoice.