Regional differences, repeated use, and costs of emergency medical services in Germany

Little is known about regional differences regarding the utilization and costs of emergency medical services (EMS) in Germany. Evidence on characteristics of repeated use of EMS is also scarce.

To compare German federal states regarding the utilization and costs of EMS and to analyze characteristics of repeated EMS use.

We used BARMER health insurance data on more than 1.4 million German EMS cases in 2022. We estimated EMS use rates (per 1000 inhabitants) and median reimbursements and costs by EMS type (ground transport with/without emergency physician (EP); helicopter emergency medical services), hospitalization status, and federal state. We applied Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI), capturing relationships between repeated use of EMS and individual characteristics, including care degree and income level.

Ground transport EMS use rates varied between federal states by more than 2.6-fold without EP (Bavaria: 84.6; Berlin: 223.2) and 2.1-fold with EP (Bremen: 19.1; Saxony: 41.3). Median reimbursement of ground transport with EP was 132% higher in Schleswig-Holstein (€ 1530) compared with Berlin (€ 660). Approximately one-third of all persons used EMS more than once and accounted for two-thirds of all EMS cases. Repeated EMS use was strongly related to care degree (IRR of care degree 5: 3084; 95% CI 3.012-3.158) and low income (IRR: 1.174; 95% CI 1.161-1.189).

The substantial regional heterogeneity in terms of utilization and costs of EMS calls for a nationwide, consistent regulation of EMS in Germany. Additionally, (outpatient) primary nursing care of persons with severe health impairments and health literacy should be strengthened.