Hospital-to-hospice transfers in Germany: analyzing the impact of age and gender at the care transition interface

Background Hospice care models vary worldwide due to differences in healthcare systems, cultural attitudes, and resource availability. In Germany, inpatient hospice care plays a vital role in the treatment of critically ill patients, providing inpatient end-of-life care if home care is not possible. The transition between different care settings is a critical interface. This study analyzes aggregated 2023 hospital data to assess the frequency and characteristics of direct transfers from hospitals to inpatient hospices and evaluates the impact of regional infrastructure on these transitions. Methods We conducted a cross-sectional analysis of aggregated data from all German hospital stays in 2023, using nationwide hospital billing data reported under §21 of the Hospital Remuneration Act. The study included adult cases and employed linear regression to examine the association between regional bed density and transfer rates. Results In 2023, 15,656 cases resulted in a transfer to an inpatient hospice. This transfer rate varied by region, with the highest rates in Saarland and Brandenburg (0.2% and 0.19%, respectively) and the lowest in Bavaria (0.05%). Hospital to hospice transfers accounted for 32.7% of all hospice admissions. Over 75% of hospice transfers were aged 65 or older. Female patients comprised 53.6% of the hospice transfer cohort, reflecting a significant disparity likely linked to limited informal spousal support. Oncological diseases were the primary diagnosis in 68.8% of cases. Transfer rates correlated strongly with regional hospice bed density (R 2 = 0.65) but showed no association with outpatient palliative care density or socioeconomic indicators. Conclusions Hospital-to-hospice transfers in Germany follow a supply-driven logic where regional capacity outweighs clinical demand. These transitions primarily involve elderly patients and women vulnerable to the collapse of informal support networks. As healthcare policy seeks to integrate inpatient and outpatient sectors, these findings serve as a benchmark for transitioning toward a needs-oriented planning model to ensure equitable end-of-life access.