Hospitals factor crisis into their plans as new revenue pressures deepen structural imbalances

• Losses reach record levels: 73 percent of hospitals ended 2025 with a deficit. More than half recorded losses equivalent to 10 to 25 percent of revenue.
• Deficits are already built into budgets: 84 percent met their financial plan targets, even though around three-quarters were in the red. Meeting targets is therefore no longer evidence of financial stability.
• Additional revenue pressure hits hospitals with no financial buffers: Hospitals expect the Statutory Health Insurance Contribution Rate Stabilization Act to reduce revenue by an average of seven percent in 2027. More than half intend to postpone or cancel investments.

Munich, October 30, 2026

Germany's hospitals are facing mounting financial pressure. Although the proportion of loss-making hospitals declined slightly in 2025, the scale of their losses increased dramatically. These are the findings of the Roland Berger Hospital Study 2026, which surveyed around 600 executives from Germany's hospital sector in June and July this year. According to the study, 73 percent of the hospitals surveyed report deficits. More than half end the financial year with losses equivalent to 10 to 25 percent of revenue. Only around one in ten achieved a positive profit margin.

Planning becomes more accurate, but not more profitable

At the same time, hospitals are becoming significantly better at forecasting their financial performance: 84 percent met the annual earnings target set in their financial plans in 2025, compared with only around half in previous years. However, this greater accuracy is not a sign of recovery. Almost four in five loss-making hospitals met their targets because anticipated losses had already been factored into their plans. For executive management and supervisory bodies, this brings a new question into focus: not whether a target has been met, but whether the planned result is sustainable in the long term.

The outlook also remains challenging. Around two-thirds of hospitals expect lower annual earnings and a further deterioration in liquidity by the end of 2029. Expectations brighten only partially for the period through 2031: Almost half still anticipate declining earnings, while only one in four hospitals expects an improvement. 45 percent consider their current liquidity to be at risk or at serious risk.

Seven percent revenue decline increases the urgency to act

The Statutory Health Insurance Contribution Rate Stabilization Act will add another source of pressure in 2027. On average, hospitals expect a seven percent loss of revenue. They see the biggest risks in the removal of funding to cover collectively agreed pay increases, expanded audit rules and the elimination of flat-rate supplementary payments. Just over one-third of hospitals expect this to place a significant strain on their multi-year financial planning, while one-quarter consider their continued operation to be at risk without structural intervention.

“More than half of hospitals are postponing investments to cushion revenue pressures in the short term. While this temporarily improves earnings and liquidity, losses have now become too high. No hospital will be able to secure its long-term future without strategic and structural measures that demand significant effort from many stakeholders,” says Peter Magunia, Senior Partner at Roland Berger.

So far, hospitals have primarily responded with operational measures: Around nine in ten plan workforce measures outside nursing, while just over two-thirds in each case intend to take action in nursing and in areas such as task allocation, documentation, coding, discharge management and non-personnel costs. By contrast, only 49 percent cite structural measures.

About the study

The Roland Berger Hospital Study 2026 surveyed around 600 executives from German hospitals. The survey was aimed at managing directors and medical directors. It covers hospitals across different levels of care and ownership models, from basic and standard care providers to maximum-care hospitals and university hospitals.

About Roland Berger
Roland Berger is the only leading global strategy consultancy of European origin. The firm combines deep industry expertise with broad experience across core management functions and transformation programs. Founded in 1967 and headquartered in Munich, Roland Berger supports companies worldwide in shaping and executing complex transformations – from strategic repositioning and performance improvement to the development and application of data-driven, AI-enabled solutions. Roland Berger is working towards achieving its company-wide net-zero emission reduction targets by 2040, validated by the Science Based Targets initiative. The firm’s progress is documented in its annual ESG report. In 2025, Roland Berger generated revenues of over EUR 1 billion.