Polyclinics - model of the future for outpatient healthcare?

We received the following contribution from Petra Stanius from the Oberhausen Alliance for Decent Healthcare, who is also active in the Care Revolution network. Thank you very much!

For a year now, we, the Oberhausen Alliance for Decent Healthcare, have been working intensively on the topic of "outpatient care": we are concerned with the question of how outpatient healthcare in Oberhausen can be ensured and improved in the future.

This question currently arises for several reasons:

As part of the new hospital planning, inpatient beds are to be reduced and treatments shifted to the outpatient sector. However, individual wards or entire hospitals have already been closed in recent years (not only) in Oberhausen and the surrounding area.

With the takeover of KKO by AMEOS in 2019, the Joseph-Hospital in Oberhausen-Mitte has already ceased to exist as a general hospital. Only the psychiatric ward remains there. And AMEOS has since closed one department after another at Marienhospital in Osterfeld.

Now the Marienhospital has been left empty-handed in the allocation of service groups as part of hospital planning - and has thus been completely eliminated as an inpatient provider.

This is probably just the beginning - because this development is politically desired.

The need for outpatient facilities is therefore already considerable and will continue to grow in the foreseeable future. But if we take a look around our city, we realise that
There are already shortcomings and gaps in outpatient care. And there are no plans to expand outpatient facilities. On the contrary, there are signs of a shortage of doctors in Oberhausen if no countermeasures are taken:

As of 1 January 2024, 56 of the 123 practising GPs were over sixty years old. Only 36 GPs - just 20.3% - are forty-five or younger. The situation is similar for specialist care.

So where should we go in the future when there are already long waiting times for (specialist) appointments in surgeries and outpatient clinics? And the distances for treatment are getting longer and longer?

"Well cared for in Oberhausen?"

In June 2024, together with ver.di Ruhr-West, we organised a panel discussion entitled "Well cared for in Oberhausen?" with representatives from politics and administration on the one hand and employees and users of healthcare facilities on the other. In January 2025, we discussed the same questions with interested citizens.

One result of the discussion in January was that contact points with emergency care and doctors in the most important specialisms that are close to home, low-threshold and accessible around the clock would significantly improve the care situation.

In this context, the term "polyclinics" has come up time and again recently. Could such multi-professional district health centres also be a model for the future of outpatient healthcare in Oberhausen?

Polyclinics - model of the future?

On 30 June 2025, supported by the Verein zur Förderung eines solidarischen und öffentlichen Gesundheitswesens NRW e.V., we held a third event to discuss this concept.

We invited Katharina Schwabedissen, trade union secretary for health, social affairs, education and science at ver.di Ruhr West, and Jens Eyding from Bochum Gesund und Solidarisch e.V. to join us.

Petra Stanius began by introducing the Oberhausen alliance and the intention of the event.

Katharina Schwabedissen then provided the participants with the necessary background knowledge. In her detailed and vivid presentation, she explained why shifting treatment to the outpatient sector could open the door for local polyclinics. And why, despite all their advantages, there is strong political resistance to the establishment of polyclinics.

To make this clear, she had to go a long way: Because the structural changes in inpatient care since the 1970s play a significant role in this context.

Hospitals: from a public service to a factory

For several decades, hospitals were treated as a service of general interest, for the fulfilment of which the state was ultimately responsible. The resources they needed for this were fully financed by the hospitals according to the principle of cost recovery. Making a profit was prohibited.

In the 1980s and 1990s, the narrative of the alleged cost explosion in the healthcare system emerged - which has long since been refuted. It was accompanied by the claim that "private" could do everything better and cheaper than the "state".

The financing of hospitals was switched to flat rates per case (DRG), and profits from therapies became possible. This made hospitals interesting for profit-orientated private investors. Since then, hospitals have been run as companies that are primarily committed to generating profits.

The now well-known and lamented underfunding of hospitals has therefore been decided politically. However, "underfunding" does not mean that hospitals as a whole cost less money as a result. On the contrary, the German healthcare system is expensive by international standards - without the quality of care being consistently high.

Even in the days of the principle of cost recovery, funds were misused - but the flat rate per case system actually rewards misuse. This can be seen, for example, in the unusually high number of (lucrative) knee operations and the distribution of our health insurance contributions to the shareholders of private clinics.

But it is not only private hospital operators that follow economic logic. Hospitals in public ownership or run by non-profit organisations are also subject to this logic.

This logic has driven up the number of unnecessary operations, led to irresponsible cuts in nursing staff, outsourced cleaning and service staff with poor working conditions, ruined once efficient hospitals...

What is needed is a return to what hospitals actually are: Namely, see above, a public service task.

Where is the outpatient sector heading?

Despite the negative experiences with the economisation of hospitals, there is currently a danger that a very similar development will follow in the outpatient sector.

The growing outpatient sector threatens to become a new field for the activities of profit-orientated corporations and investors, also because the profit prospects in the inpatient sector are falling.

In order to stop the further destruction of inpatient care and prevent a comparable economisation of outpatient care in the first place, hospitals and medical care centres (MVZ) need to be prohibited from making a profit.

The declining number of doctors in private practice shows that the small business of having your own medical practice is a model of the past. In MVZs, doctors also work as employees - with regular working hours and without the risk of over-indebtedness. The number of MVZs is constantly increasing.

Local authorities are in demand as operators of MVZs. The facilities should be financed in line with demand according to the principle of cost recovery.

This is not about more money flowing into the system, but about the use of the budgeted money for good healthcare. And this is based on need. What do we need in terms of healthcare services and facilities? This need must first be determined in a democratic process.

If the facilities are properly equipped, it will also be possible to provide outpatient treatment that is currently provided on an inpatient basis. Too few resources are currently being channelled into prevention or support in difficult life situations.

The rigid separation of the inpatient and outpatient sectors prevents a holistic concept - and therefore optimal care. Different professional groups, including non-medical ones, are needed to provide good care.

Polyclinics offer low-threshold, holistic, interdisciplinary care, where different professional groups work in a network and prevention takes centre stage. Such health centres, run by local authorities or non-profit associations, for example, in every district, would be precisely the facilities we need to expand outpatient care.

There is nothing good but...

However, Katharina Schwabedissen gave little hope that political action would move in this direction. On the contrary: the coalition agreement between the CDU and SPD favours the primary doctor system - despite the well-known shortage of GPs. Medical and non-physician professional groups are not to cooperate on an equal footing based on their respective knowledge and skills. Instead, politicians are striving for a doctor-orientated, highly hierarchical system of cooperation. The politicians in charge clearly do not want to learn anything from good examples, including from their own past.

The speaker's conclusion:
We have to do it ourselves! - the health alliances, the polyclinic syndicate...

Jens Eyding started at this point with a practical example:

He reported on his group, which is campaigning for a healthcare system in the east of Bochum that is based on solidarity and the common good. To this end, the participants founded an association in December 2024: Bochum Gesund und Solidarisch - BoGeSo e.V. (see https://bogeso.de).

Their aim is to establish a district health centre that works along the lines described above. It is important to those involved to be able to realise something themselves. Some of them have medical knowledge as doctors, for example, but none of them have real estate or other significant financial resources. So they cannot create this centre themselves. But they also don't want to wait until a complete project is in place at some point.

At the LutherLAB in Bochum-Langendreer, BoGeSo invites local residents to medical lectures to promote their health literacy. The organisation aims to strengthen people's health self-determination through public discussion, promote solidarity and encourage them to take action.

After all, Jens Eyding is convinced that when citizens get involved, politicians will get involved too.

The umbrella organisation for solidarity-based health centres in Germany is the Polyclinic Syndicate (see https://www.poliklinik-syndikat.org/)

One problem faced by all groups involved in or in the spirit of the Polyclinic Syndicate is the financing of their projects. Their aim is to involve local authorities and the Association of Statutory Health Insurance Physicians. And that is difficult. In politics, it is undisputed that the flat rate per case system (DRG) must be changed. However, the affected estates are opposed to losing money and status.

There is no ready-made concept for a solidarity-based healthcare centre that is suitable for every location. But there are very different attempts to create such centres.

The speaker mentions the St. Vincenz health centre in Essen-Stoppenberg as an interesting project: the Federal Joint Committee (G-BA) considers it to have a promising future and is funding it for two years. After that, further funding via daily flat rates appears politically possible. The city of Essen has a 49% stake in St. Vincenz - a step in the right direction.

If an MVZ is established in the east of Bochum, the association would like to be involved as an advisory member. BoGeSo's next step is to enter into dialogue with Bochum's parliamentary groups.

What can be done?

In the discussion that followed, participants from Mülheim and Duisburg reported that investor-driven medical care centres had been set up in (former) shopping centres there - primarily with a view to attracting a wealthy clientele.

A municipal health centre had been set up in Geldern. Numerous doctors immediately applied to work there. The argument that doctors' positions could not be filled for the low salary compared to the fee was therefore not true.

One participant was annoyed that representatives of the Oberhausen city council and administration played down problems such as the shortage of GPs and long waiting times or did not address them at all. And conveyed to the outside world that everything was in perfect order.

The city of Oberhausen recently had to reduce the planned one hundred public water dispensers to ten: Whether or not summer heat poses a health risk to the population, there is no money for prevention.

It's really not a good idea to rely on politics when it comes to our health. Without pressure from below, nothing will happen - regardless of who is in control.

With the closure of the Marienhospital, the range of medical services in Oberhausen-Osterfeld has deteriorated significantly.

What do the people there need in order to be well cared for?

Perhaps a polyclinic in the former Marienhospital, based on solidarity and orientated towards the common good - without profits for AMEOS?

We can ask them.