[Between Tuition Fees and Trainee Allowances: Financing of Schools in the German Health Care System].

Introduction: Schools in the health sector play a significant role in the structure of the German education system. In addition to public schools, there are numerous schools, either substitute or supplementary, in the private sector. Many schools are directly attached to a hospital, in contrast to others operating financially independently having cooperation agreements with corresponding facilities for practical training. This article explains the differences between public, substitute and supplementary schools in the health care sector, with particular emphasis on their financing. It also shows the impact of the integration of a school at a hospital.

Methods: The information regarding the types of schools was generated through expert interviews and by reviewing current laws. A schematic illustration is intended to promote further understanding of school financing in the health care sector, thus contributing to more transparency.

Results: The legal framework conditions for the professions of physiotherapy, occupational therapy and speech therapy are elaborated, as well as basic German Law forming the legal basis for the Hospital Financing Act (KHG). The financing of public schools is regulated by law and is carried by the respective state or municipality. This also applies to public schools in the health care sector. Uniform regulations are also applicable to replacement and supplementary schools falling under the KHG. Trainees receive a salary if their schools cooperate with hospitals with which corresponding funding agreements are in place. However, private schools not affiliated with the KHG training fund must rely on alternative sources of funding, ultimately leading to the necessity to charge tuition fees.

Conclusion: Different federal/state-specific regulations contributing to the financing of health care education is often unclear and incomprehensible. Due to current laws, tuition-free education cannot be guaranteed in every federal state or at every school. It remains to be seen if or to what extent changes will take place leading to uniform, transparent and comprehensible financing of the training landscape in the health professions in the German education system.