[Excerpt] Over the past decade, German hospitals have been privatised at a rate not seen in any other country. In response to massive public-sector debt and the resulting investment backlog, many state and local governments have been privatising hospitals. The most common arguments for privatisation are repeated in a recent study commissioned by the association of private hospital owners (Bundesverband Deutscher Privatkliniken - BDPK) namely that private hospitals manage in a more efficient manner and are economically more successful (Augurzky, Beivers et al., 2009). Indeed, in some cases, private for-profit hospital companies have invested generously and turned inefficient public hospitals into profitable private ones. Of interest to us is the cost of this trend, to workers and patients.
Assertions that privatisation has not undermined the quality of care are highly dubious. In German public opinion, there is broad scepticism about the privatisation of hospitals. While there are very few scientific studies on the effects of privatisation on patients, there are a growing number of local ballot initiatives and other campaigns to fight it. There are widespread fears that for-profit health-care provision would undermine the existing system, which provides universally accessible medical treatment at a relatively high level of quality. Even among physicians, often considered the winners of privatisation, there is scepticism (Bundesärztekammer, 2007).
We will argue below that one reason for these problems is the effect of privatisation on employees. Trade unionists and works councils in privatised hospitals have seen a severe deterioration in working conditions (Ver.di Vertrauensleute und Vorsitzende und Mitglieder von Konzernbetriebsräten und Konzern-Jugend- und Auszubildenden-Vertretungen privater Krankenhauskonzern, 2008). Since personnel accounts for about 60 per cent of hospitals’ overall costs (Statistisches Bundesamt, 2008b), private for-profit hospitals can only make profits at the expense of employees. These perceptions are supported by the statistics presented in this paper, and trade unions and employees protest — in cooperation with other parts of civil society - almost every planned privatisation.
Drawing on publicly available quantitative data and qualitative interviews, we map out in this paper the trend toward the privatisation of German hospitals. We begin by showing how and why privatisation has proceeded in Germany despite the controversy. Then we examine the effects of privatisation on workers and patients. We will conclude with some implications for policy and practice.