Representativeness of the European social partner organisations: Hospitals – Germany
The aim of this representativeness study is to identify the respective national and supranational actors (i.e. trade unions and employer organisations) in the field of industrial relations in the hospital sector in Germany. In order to determine their relative importance in the sector’s industrial relations, this study will, in particular, focus on their representational quality as well as on their role in collective bargaining.
1. Sectoral properties
In Germany, in 2007, hospitals were one of the few sectors providing for job growth. However, the increase in the employment figures is mainly due to the growth of marginal part-time work. More than 50% of employees working in public sector hospitals are covered by multi-employer agreements, while coverage rates in private hospitals are below 10% due to single-employer agreements. There is no representativeness problem in this sector; however, the situation is affected by privatisation.
| 1999 | 2006* | |
|---|---|---|
| Number of employers* | n.a. | 3,895 (2004) |
| Aggregate employment* | n.a. | n.a. |
| Male employment* | n.a. | n.a. |
| Female employment* | n.a. | n.a. |
| Aggregate employees* | 1,229,422 liable for social security contribution plus 30,177 marginal part-time workers not liable for social security contribution | 1,252,910 liable for social security contribution plus 53,471 marginal part-time workers either not liable for social security contribution or liable for social security contribution in another job |
| Male employees** | 283,364 | 300,772 |
| Female employees** | 943,581 | 952,138 |
| Aggregate sectoral employment as % of total employment in economy | n.a. | n.a. |
| Aggregate sectoral employees as % of total number of employees in economy*** | 4.5% | 4.6% |
Notes: * Federal Statistical Office, Company Register (Unternehmensregister). Data refer to employees plus self-employed persons and temporary agency workers in 2004. ** Data from Federal Employment Agency. Figures include employees liable for social security contributions as well as part-time workers not liable for social security contribution. ***Employees liable for social security contribution only.
2. The sector’s unions and employer associations
This section includes the following trade unions and employer organisations:
1. trade unions which are party to sector-related collective bargaining;
2. trade unions which are a member of the sector-related European federation, the European Federation of Public Service Unions (EPSU);
3. employer organisations which are party to sector-related collective bargaining;
4. employer organisations which are a member of the sector-related European employer federation, the Hospital and Healthcare European Employers’ Association (HOSPEEM).
2a Data on the unions
The following five trade unions are active in the hospital sector:
- United Services Union (Vereinte Dienstleistungsgewerkschaft, Ver.di);
- German Civil Service Association (Deutscher Beamtenbund, DBB);
- Hospital Doctors’ Trade Union (Marburger Bund);
- Health Sector Employees Union (Gewerkschaft für Beschäftigte im Gesundheitswesen, BiG);
- Trade Union of Public and Private Services (Gewerkschaft Öffentlicher Dienst und Dienstleistungen, GÖD).
2a.1 Type of membership (voluntary vs. compulsory)
Voluntary.
2a.2 Formal demarcation of membership domain (e.g. blue-collar workers, private sector workers, service sector employees, etc)
Demarcation lines are self-defined.
Ver.di organises all workers in the sector, including medical doctors.
DBB represents public servants as well as all other employees working in public services.
Marburger Bund only organises medical doctors – employees and civil servants.
BiG was established to represent nursing staff in the public sector, but decided in 2000 to broaden its domain to all employees working in the health sector.
GÖD organises all hospital workers.
2a.3 Number of union members (i.e. the total number of members of the union as a whole)
Ver.di: 2,274,731 members in 2006, according to the trade union.
DBB: 1,250,000 members in 2006.
Marburger Bund: 108,000 members in 2007, according to the trade union.
BiG: 1,600 members in 2007, according to the German parliament (Deutsche Bundestag) registry of organisations (Registrierte Verbände (in German, 5.6Mb PDF)).
GÖD: No information.
2a.4 Number of union members in the sector
Ver.di: No data on hospital sector available. In the overall health sector, there are about 348,500 members as at December 2006.
DBB: No information.
Marburger Bund: 81,000 members.
BiG: No data on hospital sector available.
GÖD: No information.
2a.5 Female union members as a percentage of total union membership
Verdi: 49.8%.
DBB. 32%.
Marburger Bund: 46%.
BiG: No information.
GÖD: No information.
2a.6 Density with regard to the union domain (see 2a.2)
Ver.di: No information available.
DBB: No data.
Marburger Bund: 46%.
BiG: No information.
GÖD: No information.
2a.7 Density of the union with regard to the sector
Ver.di: No information available.
DBB: No data.
Marburger Bund: 77%.
BiG: No information available.
GÖD: No information available.
2a.8 Does the union conclude collective agreements?
Ver.di and DBB form a bargaining alliance when bargaining with the employer organisations TdL and VKA (see below).
Marburger Bund: Yes.
BiG has concluded one single-employer collective agreement.
GÖD: Yes.
2a.9 For each association, list their affiliation to higher-level national, European and international interest associations (including cross-sectoral associations).
Ver.di: Confederation of German Trade Unions (Deutscher Gewerkschaftsbund, DGB); EPSU.
DBB: European Confederation of Independent Trade Unions (Confédération Européenne des Syndicats Indépendants, CESI).
Marburger Bund: EPSU.
BiG: No data available.
GÖD: Christian Trade Union Federation (Christlicher Gewerkschaftsbund, CGB).
2b Data on the employer associations
The following three employer organisations are present in the hospital sector:
- Municipal Employers’ Association (Vereinigung der kommunalen Arbeitgeberverbände, VKA);
- Employers’ Association of the Länder (States) (Tarifgemeinschaft deutscher Länder, TdL);
- Federal Association of German Private Hospitals (Bundesverband Deutscher Privatkliniken e.V., BDPK).
The charity organisations Caritas of the Catholic Church and Diakonie of the Protestant church also operate hospitals. However, these organisations are regulated by church law. Therefore, they are not part of collective bargaining and are not included in this section.
2b.1 Type of membership (voluntary vs. compulsory)
Voluntary.
2b.2 Formal demarcation of membership domain (e.g. SMEs, small-scale crafts/industry, health services, etc)
VKA organises hospitals of all sizes and all medical branches.
TdL represents all federal states apart from the eastern state of Berlin and the central state of Hesse. TdL thus comprises hospitals of all sizes and medical branches apart from those in Berlin and Hesse.
BDPK represents hospitals of all sizes and medical areas.
2b.3 Number of member companies (i.e. the total number of members of the association as a whole)
VKA represents 16 members, that is, regional associations.
TdL represents 14 members, that is, the federal states mentioned above.
BDPK represents about 460 member companies.
2b.4 Number of member companies in the sector
VKA represents 16 members, which operate about 650 hospitals at local level.
TdL members operate around 30 university hospitals and another eight to 10 psychiatric hospitals.
BDPK represents about 460 member companies, managing around 1,000 hospitals.
2b.5 Number of employees working in member companies (i.e. the total number of the association as a whole)
VKA members employ a total of about two million employees across all sectors.
TdL: No data.
BDPK member companies employ about 248,000 employees.
2b.6 Number of employees working in member companies in the sector
VKA members employ about 450,000 employees in their hospitals.
TdL: No data.
BDPK member companies employ about 248,000 employees.
2b.7 Density of the association in terms of companies with regard to their domain (see 2b.2)
VKA: Not available.
TdL: Not available.
BDPK reports a density of 79%. The association indicated that the statistical dataset of the German Hospital Federation (Deutsche Krankenhausgesellschaft, DKG) identifies 3,628 hospitals as well as rehabilitation centres in Germany. Out of these, 1,270 hospitals would be privately operated; 1,000 hospitals are organised by BDPK. It should be noted that BDPK defines its domain as private hospitals only.
2b.8 Density of the association in terms of companies with regard to the sector
VKA: Not available.
TdL: Not available.
BDPK: About 28%, as defined by BDPK.
2b.9 Density in terms of employees represented with regard to their domain (see 2b.2)
VKA: Not available.
TdL: Not available.
BDPK: 83%. BDPK indicated that 1.1 million employees in Germany work in hospital activities or NACE 85.11, according to the General industrial classification of economic activities within the European Communities (Nomenclature générale des activités économiques dans les Communautés européennes, NACE). Out of these, about 300,000 employees work in private hospitals. BDPK members employ 248,000 employees in private hospitals.
2b.10 Density in terms of employees represented with regard to the sector
VKA: Not available.
TdL: Not available.
BDPK: Not available.
2b.11 Does the employer association conclude collective agreements?
VKA concludes collective agreements for its members. However, the member regional associations have the option of concluding complementary regulations.
TdL concludes collective agreements.
BDPK concludes collective agreements. However, BDPK also indicated that several regional member associations still conclude their own collective agreements, such as the regional associations of Baden-Württemberg and Bavaria in the south, Hesse, and Rhineland-Palatinate and North Rhine-Westphalia in the west.
2b.12 For each association, list their affiliation to higher-level national, European and international interest associations (including the cross-sectoral associations).
VKA is a member of the Association of Public Service Employees (Beschäftigtenverband öffentlicher Dienst, BVöD). The latter is a member of the European Centre of Enterprises with Public Participation and of Enterprises of General Economic Interest (Centre européen des entreprises à participation publique et des entreprises d’intérêt économique général, CEEP).
TdL indicated that it is not to a member of any European or international interest association.
BDPK is a member of the European Union of Private Hospitals (Union Européene de l’Hospitalisation Privée, UEHP).
3. Inter-associational relationships
3.1. Please list all unions covered by this study whose domains overlap.
The organising domains of all of the above trade unions overlap.
3.2. Do rivalries and competition exist among the unions, concerning the right to conclude collective agreements and to be consulted in public policy formulation and implementation?
Rivalries exist, but do not relate to the formal right to conclude collective agreements.
3.3. If yes, are certain unions excluded from these rights?
No.
3.4. Same question for employer associations as 3.1.
The domains of VKA, TdL and BDPK do not overlap.
3.5. Same question for employer associations as 3.2.
No.
4. The system of collective bargaining
4.1. Sector’s rate of collective bargaining coverage
According to trade union estimates, only about one third of all west German hospital sector employees and around a quarter of all east German hospital workers are covered by collective agreements. This estimate is based on the fact that about one third of all hospitals are run by charity organisations and about one third are private companies which have not concluded a collective agreement.
A survey by the German Hospital Institute (Deutsche Krankenhaus Institut) also shows a large discrepancy between the coverage rate of employees working in public and private hospitals. The results are published in the ‘Krankenhaus Barometer 2007’ (in German, 494Kb PDF). No overall figures are given.
The coverage rate of white-collar and blue-collar hospital workers, excluding medical doctors, is as follows:
- working in west German public hospitals – 51.8%;
- working in east German public hospitals – 46.1%;
- working in private hospitals – west 3%, east 7.2%.
In west Germany, about 55.6% and in east Germany about 59.1% of all medical doctors working in public hospitals are covered. However, in private hospitals, collective agreements only cover 5.3% (west) and 15.5% (east) of medical doctors.
4.2. Relative importance of multi-employer agreements and of single-employer agreements as a percentage of the total number of employees covered
All hospital workers, including medical doctors, working in public hospitals are covered by multi-employer agreements (see above).
4.2.1. Is there a practice of extending multi-employer agreements to employers who are not affiliated to the signatory employer associations?
There is no such formal practice.
4.3. List all sector-related multi-employer wage agreements* valid in 2005 (or most recent data).
* Only wage agreements which are (re)negotiated on a reiterated basis. In case of regionally differentiated, parallel agreements, an aggregate answer explaining the pattern may be given.
| Bargaining parties | Purview of sector-related multi-employer wage agreements | ||
|---|---|---|---|
| Sectoral | Type of employees | Territorial | |
| Ver.di and DBB; VKA | Public sector, including hospitals owned by municipalities | All blue-collar and white-collar employees of hospitals | Germany |
| Ver.di and DBB; TdL | Public sector, including hospitals and university hospitals owned by the Länder | All blue-collar and white-collar employees of hospitals | Germany |
| Marburger Bund; VKA | Hospitals | Medical doctors including dentists but excluding chief physicians | Germany |
| Marburger Bund; TdL (DE0607019I) | University hospitals | Medical doctors including dentists | Germany |
5. Formulation and implementation of sector-specific public policies
5.1. Are the sector’s employer associations and unions usually consulted by the authorities in sector-specific matters? If yes, which associations?
Trade unions:
Ver.di is typically consulted by the Health Commission of the German parliament.
DBB: No information.
Marburger Bund: No.
BiG did not provide information in this regard.
GÖD: No information.
Employer organisations:
With regard to public health policies or legislation, BDPK is usually consulted by the parliament.
VKA and TdL are also consulted by public authorities.
5.2. Do tripartite bodies dealing with sector-specific issues exist?
No.
6. Statutory regulations of representativeness
6.1. In the case of the unions, do statutory regulations exist which establish criteria of representativeness which a union must meet, so as to be entitled to conclude collective agreements?
No.
6.2. In the case of the unions, do statutory regulations exist which establish criteria of representativeness which a union must meet, so as to be entitled to be consulted in matters of public policy and to participate in tripartite bodies?
No.
6.3. Are elections for a certain representational body (e.g. works councils) established as criteria for union representativeness?
No.
6.4. Same question for employer associations as 6.1.
No.
6.5. Same question for employer associations as 6.2.
No.
6.6. Are elections for a certain representational body established as criteria for the representativeness of employer associations?
No.
7. Commentary
The hospital sector is strongly affected by privatisation, a process that has led to a steady decline in the coverage rate of collective agreements. The employer organisation representing private hospitals, BDPK, cancelled the multi-employer collective agreement in 1993; since then, a new agreement has not been concluded. Company agreements covering all hospitals owned by a private company are exceptional. Single-employer agreements typically only cover a minority of the private hospitals.
A considerable number of hospitals are church-owned or belong to non-profit organisations and are, according to German law, excluded from collective bargaining. According to trade union information, multi-employer wage contracts in church-owned hospitals tend not to meet the standards set by trade unions in collective agreements.
Overall, there is no representativeness problem in the sector.
Birgit Beese, Institute of Social and Economic Research (WSI) and Sandra Vogel, Cologne Institute for Economic Research (IW Köln)