Date 2023.03.17

During the coronavirus pandemic, public health services were overburdened not least because of years of budget cuts. They were not able to fully perform their mission – of protecting the health of all citizens. Therefore, the Federal Government provided the federal states with €3.1 billion for additional staff. In future, regional and local governments need to be responsible for their own staff costs again and to make public health offices resilient to crises – that is our recommendation in a current advisory report to the German Parliament.

The coronavirus pandemic marked a turning point for the German healthcare system. The condition of public health services, in particular of the public health offices, clearly reflected the years of budget cuts at regional and local level. As a result, the Federal Government and the federal states concluded a pact for public health services to modernise and sustainably strengthen the system. The pact is funded by the Federal Government with a total volume of €4 billion. Out of this amount, €3.1 billion alone are budgeted to fund staff growth at regional and local level.

However, it remains open whether public funds of €3.1 billion were really required since the relevant Federal Ministry of Health (Ministry) failed to adequately document the negotiations with the federal states on the pact. Therefore, the assumptions and calculations underlying staff growth targets are not transparent.

The Federal Government provides the federal states with funds by adjusting the vertical apportionment of VAT. These funds are allocated to the budgets of the federal states without earmarking. In return, the federal states pledged to provide evidence for staff growth. However, they have so far only given incomplete and vague information. Nevertheless, the Ministry did not see any reason to verify the statements made by the federal states.

Financial responsibility lies with regional and local governments

In mid-2023, the Federal Government and the federal states intend to reach agreement on “sustainably funding” staff growth. It is clear that the federal states demand that staff growth is permanently funded at the expense of the Federal Government. Pursuant to the German Constitution, however, the regional and local governments are exclusively responsible for ensuring the tasks and funding of public health services. The first pact has already not complied with this principle. Therefore, the Federal Government needs to remind regional and local governments of their own responsibility for staff costs incurred by public health services.

Fundamental reforms required

The situation in public health offices and in the entire healthcare system is tense even “after” the coronavirus pandemic. Despite financial incentives and repeated job advertisements, many posts and positions remain vacant. Because of the high workload, the majority of public health offices could no longer perform all of their duties.

In principle, we support the objective of the pact – however, sustainable structures need to be created for reliable public health services. This includes comprehensive reforms with fixed deadlines. Scientific advice on sustainable structures in public health services should be taken into account. This is the basis for an efficient use of staff and resources.