Germany invests more in health than almost any other country in the world. But without interoperability, AI, and precision medicine, it won’t work. The transformation fund could bring about change – if it is used correctly.
Last year, Germany invested around €538 billion in its healthcare system, roughly 12 percent of its gross domestic product – and the trend continues upward. However, this record figure does not automatically guarantee efficiency or quality. Life expectancy remains around 1.7 years below the Western European average, while health insurance companies and hospitals are coming under pressure: in 2024, the deficit of statutory health insurance was 6.2 billion euros. The average additional contribution in 2025 was 2.5 percent. In 2026, it will even rise to 2.9 percent.
Three-quarters of hospitals are operating at a loss, and the medium-term investment required for modernization and digitization is estimated at around €130 billion. At the same time, the digital infrastructure remains fragmented: a lack of interoperability, isolated solutions, and slow implementation lead to duplicate examinations, data breaches, and high costs. At the same time, the system must also function reliably under exceptional stress – as was recently the case during the power outage in Berlin. This requires “health security” as a guiding principle: digital reporting and early warning chains, as well as crisis-proof and blackout-proof IT, including secure communication channels.
Standards such as ISiK (Information Technology Systems in Hospitals), Fast Healthcare Interoperability Resources (FHIR) for electronic data exchange in healthcare, and MIOs (Medical Information Objects) are now well established. In addition, acceptance of artificial intelligence is growing: 74 percent of Germans see benefits for second opinions, 72 percent for diagnoses. Precision medicine is also available – over 140 active ingredients require molecular testing, especially in oncology. However, implementation is stalling due to a lack of reimbursement and infrastructure.
One possible solution: the transformation fund for modernizing hospital structures. It is the key instrument for making inpatient care in Germany fit for the future. With a volume of up to €50 billion between 2026 and 2035, the fund will be used to modernize hospitals, eliminate duplicate structures, and consistently drive forward digitalization. The goals are clear: specialization of care, expansion of telemedicine services, and the introduction of an efficient electronic patient record (ePA). These measures are intended to increase efficiency, quality of care, and patient safety.
However, the Hospital Transformation Fund should do more than just modernize buildings and structures. It is an opportunity to invest specifically in sustainable digital infrastructures. Instead of fragmented individual solutions, the focus should be on interoperable, scalable platforms that really improve care. When doctors are asked what currently causes them the most stress in their daily work, the answers very often include “documentation” and “administrative tasks.” We can use artificial intelligence to reduce the proportion of these tasks. At the same time, doctors can then devote more time to their patients and we can improve their care. For the transformation fund to be truly effective, it should also prioritize health security functions: joint situation/operations platforms across sectors and robust cyber resilience such as zero trust or 24/7 monitoring.
What is needed now is a clear commitment to “AI Made in Germany” – strategically promoted and bindingly enforced. Only then can genuine digital transformation and European technological leadership in healthcare be achieved.
At T-Systems, we are laying the groundwork for this: With AI Foundation Services, all the necessary basic technologies are available in a secure cloud operated in Germany. This allows many application scenarios such as ambient listening, coding agents, or patient chatbots to be set up as microservices, either on-premises or hybrid. Raw data remains in the hospital network, while AI execution migrates to the secure layer in the T Cloud. The platform concept, rather than a small specialized solution, provides the turbo boost for scaling and innovation.
One example of the use of AI Foundation Services is T-Systems SmartChat. SmartChat brings generative AI securely to call centers, hospitals, and health insurance companies. It taps into internal knowledge bases, answers patient and insurance questions, prepares cost estimates, translates medical reports, and pre-fills forms – 24/7 in correct technical language. This AI and cloud platform can also be used to provide resource overviews and early warning dashboards for emergency situations, enabling authorities, clinics, and emergency services to network and share a common overview of the situation.
This illustrates that digitalization in the healthcare sector is continuously increasing, and we at Deutsche Telekom and T-Systems are supporting their business with a variety of solutions. Not least because of this, we have further expanded our position with the acquisition of the Austrian hospital IT specialist synedra. We are firmly committed to making an important contribution to better and more efficient healthcare and patient care.
Cloud is not an end in itself, but rather the foundation for flexible capacities, resilient IT, and clinically usable data rooms.
Dr. Gottfried Ludewig, Senior Vice President / Leader Public Sector and Health Industry Deutsche Telekom AG, T-Systems International GmbH
The top priority is to strengthen the resilience and reliability of clinical systems in order to ensure care even in crisis situations. Equally important is the implementation of telemedicine networks that enable cross-sector care and can close gaps in care, especially in rural areas. Networked medicine can only reach its full potential if it enables remote diagnostics. Modern telemedicine, AI-supported image analysis, and remote expertise create access to cutting-edge medicine – regardless of whether you live in a big city or 100 kilometers from the nearest maximum care provider. No one has to live next to a university hospital to receive the best possible care.
Modern, networked healthcare also requires secure, sovereign cloud infrastructures that process data reliably, efficiently, and in compliance with the GDPR. This is the only way hospitals, research, and healthcare can scale without slipping into new isolated solutions. The cloud is not an end in itself, but rather the foundation for flexible capacities, resilient IT, and clinically usable data rooms. A sovereign cloud is also the data space for health crises: standardized interfaces (FHIR, MIOs), terminology servers, high data quality, and complete logging ensure fast, purpose-specific data use – without isolated applications and with robust interoperability.
In addition, open, certified cloud-based healthcare platforms, semantic interoperability via FHIR and terminology servers, and consistent data management that makes clinical data available for care and research are necessary. And progress requires measurability – transparency via standards is indispensable. AI applications such as image analysis, triage, and decision support must move from pilot projects to widespread use.
The transformation fund covers telemedicine networks, robotic telesurgery, cross-sector care facilities, and precision medicine. Studies predict billions in potential savings through ePA, e-prescriptions, and automated processes. It is important that it is used correctly: emergency aid has been promised politically, and quality criteria and minimum case numbers are driving specialization forward. Telemedicine networks strengthen rural regions in particular, while robotic telesurgery allows complex procedures to be performed over long distances. Exceptional situations also require a clear legal and governance framework (emergency access, earmarking, transparency) and regular cross-sector exercises to measurably increase resilience.
According to analyses, digital processes such as e-prescriptions and automated billing can save up to ten percent in administrative costs. Governance instruments such as an interoperability score could link investments specifically to standards.
We spend over half a trillion euros – and still allow ourselves to have data silos. The transformation fund is more than just financing: it is the driving force behind patient-centered, digital, efficient care. Digital early warning chains, real-time situation reports, strong cyber resilience, and cross-sector coordination are the key factors in ensuring that care remains stable even in exceptional situations – such as recently in Berlin – and that investments have a measurable impact. 2026 must also be the starting point for binding interoperability, AI suitable for everyday use, sovereign cloud infrastructures, and comprehensive tele-diagnostics. Because small, consistently implemented adjustments will determine whether digitalization finally creates time for patients and saves billions.
