Three in four hospitals in the red, and most of them hit their plan

The consultancy Roland Berger has published this year’s edition of its annual German hospital study, based on interviews with around 600 managing directors and medical directors¹. The headline is a ledger, not a slogan. In 2025, 73% of hospitals were in the red, and at more than half of them (56%) the year-end deficit came to over 10% of revenue; at some it reached a quarter¹.

Then comes the paradox. Hospitals have become much better at predicting their own results: 84% met the annual result set in their business plan in 2025, against roughly half in earlier years¹. Roland Berger is blunt about why. “The higher hit rate is no sign of recovery,” the firm said (our translation, as are the quotes below); almost four in five loss-making hospitals met their plan because the losses had already been budgeted¹. A target met is not the same as a business that lasts.

The reserves are thinning. Many hospitals have largely used theirs up, the study says, and co-author Jonas Hollacher expects the number of insolvencies “will probably rise sharply”¹. Respondents expect the GKV contribution-rate stabilisation law, the government’s savings package for statutory health insurance, to cut their revenue by 7% on average¹. More than one hospital in two is postponing investment to cope, said senior partner Peter Magunia, which helps results and cash in the short run but not for long¹. The outlook is grey: about two-thirds expect worse results and weaker liquidity through 2029, and only one in four expects an improvement by 2031¹.

Read it the stubborn way. This is a survey of managers, not an audit, and those who run institutions have reasons to sound alarmed before a savings package. But forecasting is a skill, and the hospitals have learnt it; the question Roland Berger now puts to boards is not whether a target was met but whether the planned result is sustainable, and Magunia says no hospital will secure its future without “strategic and structural” measures¹. For you, a deferred investment is a lift that waits, a scanner that ages, a ward that is not refurbished. Nobody will announce it. You will notice it at the reception desk.