North Rhine-Westphalia's ambulance funding crisis risks billing residents for empty runs

A funding dispute in North Rhine-Westphalia is putting pressure on emergency services and local budgets. Health insurers have stopped covering the costs of 'empty runs'—callouts where ambulances respond but transport no patient. Without a solution, residents could soon face bills for these trips themselves.

The problem began when health insurers refused to pay for empty runs, citing a recent court ruling. The Higher Administrative Court of Berlin-Brandenburg found insurers were not legally required to cover such callouts. As a result, municipalities and districts now bear the rising costs, straining their finances.

North Rhine-Westphalia's Health Minister Karl-Josef Laumann had aimed for a resolution by Easter. But talks between municipal associations and insurers failed to reach an agreement. The state government is now mediating further discussions, set to resume in mid-April. One temporary fix under consideration is reverting to the old system, where insurers covered all emergency callouts, including empty runs. However, no final decision has been made. Meanwhile, the Ennepe-Ruhr district has warned that without funding changes, it may bill residents for all ambulance trips—even hospital transports—at up to €450 per journey. The NRW District Council has not ruled out patients eventually being charged for false alarms. Yet, no commune or district has concrete plans or legal steps in place to pass these costs directly to citizens.

The deadlock leaves local authorities facing tough choices. If no compromise is found, residents could soon receive bills for ambulance services previously covered by insurers. Further talks in April will determine whether a solution can be reached before costs are shifted to the public.