German district retroactively charges for emergency services amid funding gap

The district of Märkisch-Oderland in Brandenburg, Germany, has begun retroactively charging citizens for emergency medical services to address a significant deficit in its ambulance operations. The district is sending out around 2,100 fee notices for 2025, aiming to recoup approximately 2.2 million euros annually, which covers the costs of unpaid ambulance rides where patients were not admitted to a hospital.

This move comes despite the state government's announcement of providing 40 million euros annually to the districts and independent cities to support emergency services over the next two years. A spokesperson for the district, Johanna Seelig, stated that these funds might help avoid fees for 2026 but are insufficient to cover deficits from previous years, which amount to six million euros over the past three years.

The state's health ministry, represented by spokesperson Uwe Meier, views the allocated funds as a step toward a solution but acknowledges the complex negotiation landscape. The ministry stated that Märkisch-Oderland is the only district currently issuing retroactive fee notices. Together with municipal associations, health insurers, and other authorities, the ministry is working to find solutions that would exclude such retroactive and future fee notices, emphasizing that the associated anxieties and burdens far outweigh any benefits.

Traditionally, districts and independent cities cover the costs of emergency services, with health insurers reimbursing these amounts. However, this process has not always been successful. In contrast, the city of Cottbus and its insurers reached an agreement, preventing planned fee notices. A federal reform of emergency care is intended to address the issue of "misdirected trips" without hospital admission.