The healthcare industry is characterized by an exceptionally high level of regulation. Companies require room for maneuver and planning security. The potential of the healthcare industry in the areas of innovations and digital applications cannot currently be fully realized within the legal framework (e.g., MDR, IVD-R). Against the backdrop of increasing global competition and limited resources in healthcare, it is essential to ensure an innovation-friendly and internationally competitive regulatory framework, particularly for start-ups as well as small and medium-sized enterprises in the sector in Germany.

This includes equal competitive conditions for the individual players in the respective services areas (see chapter "Research and Innovation"). For market penetration of innovations, a transparent market is required. Innovations and their market introduction must not be impeded by innovation-inhibiting processes such as unnecessary bureaucratic hurdles. The two-tier, competition-based system of private and statutory health insurance ensures quick access to innovations in healthcare. Competition must be designed fairly.

Digitalisation can make a significant contribution to strengthening Germany as a research location and ensuring healthcare, especially in rural areas. The prerequisite is that digital infrastructure is expanded nationwide and data protection is designed to be user-oriented, appropriate, and uniform (see DIHK position paper on digitalisation in healthcare (PDF, 323 KB), only available in German). Start-ups and small and medium-sized enterprises, in particular, bring forth innovative digital solutions. These companies need sufficient clinical data on their products – for example, regarding therapeutic benefits – as the basis for economic success. A prerequisite for data generation is also the willingness of key players – such as university hospitals – to cooperate. The interoperability of various information systems – for example, via appropriate interfaces – is an essential requirement for leveraging the opportunities of digitalisation. Overall, companies need access to healthcare-relevant and medical health data – while complying with data protection regulations – to develop innovations. Large amounts of data (Big Data) are collected daily, which have so far been scarcely used for developing improved diagnostic and therapeutic approaches. The principle applies to all of this: Everyone must have sovereignty over their own data.

The European level forms an important starting point for digitalisation: By designing a European data space, it supports the creation of a single market for digital health services with European standards for approval and data security.

Against the backdrop of demographic changes and medical-technical advancements, it is essential to avoid further increases in labor costs through higher social security contributions in the medium and long term. A slowdown in economic dynamics in Germany would further intensify the financial pressure on the healthcare and care sectors, negatively impacting the prospects of the commercial economy regarding investment and employment in Germany. 

Therefore, not least due to the lack of financial resources in the healthcare fund, the structures of all areas of social insurance should be reviewed for their future viability and sustainability to ensure that healthcare provision remains affordable and meets the latest standards of research and development. Here, politics has a role to play in ensuring the efficient organization of care structures. This includes the assumption of financial responsibility for non-insurance-related benefits, which are not the task of the contributors (see also chapter "Comprehensively addressing the issue of securing skilled and unskilled workers, guideline "Social security sustainable design").

Preventive measures, such as corporate health management (CHM) and health promotion, help to prevent diseases, reduce absenteeism among employees, and improve their productivity. Overall, greater attention to preventive measures can help keep the costs of the healthcare system under control. Costs for prevention are economically more favorable than costs incurred due to diseases (see also chapter "Comprehensively addressing the issue of securing skilled and unskilled workers").

The systematic integration of innovative products and services into healthcare provision and a consistent use of digital medicine can contribute to a more efficient use of resources. Reducing inefficient care structures and false incentives also improves the efficiency and quality of services provided by companies in the healthcare industry. Improvements, such as in hospital and pharmacy structures, are possible. Furthermore, stronger cross-sectoral healthcare provision, increased outpatient care, a more consistent digitization across all areas of service provision, and the use of quality-oriented compensation structures could improve the framework conditions. 

More competition, for example, through greater contract freedom between insurers and service providers, can also lead to higher efficiency. For some companies, it is important to ensure a proper balance in spending across all service areas of the healthcare sector. 

The pandemic has highlighted the importance of a robust and resilient healthcare economy for the overall economy. For a resilient healthcare economy, it is essential that international supply chains function smoothly. This is because they predominantly provide companies with access to skilled professionals and medical technologies. 

Both service providers and manufacturing companies within the healthcare economy face significant burdens due to verification and documentation obligations – this is particularly true for approval processes. The conditions for companies should be designed in such a way that production in Germany or Europe is feasible—for example, by ensuring fast and legally certain planning and approval processes and reviewing requirements for drug procurement tenders. Politically desired autonomy in the production of certain goods should be based on the competitiveness of the sector. Overall, alternatives to costly reallocation of production, such as retention premiums, should also be examined.

Growth in the industrial healthcare economy relies not only on its innovative capacity but also on integration into international supply chains and robust international engagement. Export-oriented sectors face intense international competition, not least due to the demanding nature of producing innovative goods. Their complex value chains and strict quality requirements for medical products subject them to numerous regulations, especially at the EU level, such as the current IVD-R, which hampers companies in the race for swift market access, partly due to its high bureaucratic demands. For exports to succeed in key healthcare sectors – medical technology and pharmaceuticals – successful market entry, especially in the reference market of Germany, is crucial. Overlapping regulations in national, European, and international law should be avoided. Product approvals in the EU should be internationally recognised.

Germany has long been experiencing a shortage of skilled workers in the healthcare and care industries, especially in rural areas. Even today, many positions cannot be filled. This affects not only nursing and therapeutic professions or company physicians but also activities in scientific and technical fields such as biotechnology, medical technology, and the pharmaceutical sector. The result is an impact on the innovation capacity of the healthcare sector as well as the entire German economy. Enhancing the attractiveness of healthcare and care professions can help attract more young people, including those from abroad, to these professions and mitigate the shortage of skilled workers.

Against the backdrop of demographic change and medical-technological progress, healthcare and care professions as well as fields of activity should be further developed. Rapid advancements in AI and digital healthcare must also be taken into account in this context. Their product developments contribute to partially alleviating the shortage of skilled workers, making the division of labour between medicine and care more efficient, and improving data transfer between healthcare actors. Overall, it is important to enable greater permeability between professional groups.