How the German healthcare reform could affect labour migration

The shortage of skilled staff in the care sector is becoming increasingly acute as a result of demographic change. At the same time, many hospitals are holding back on new recruitment or are even making staff redundant. The reason: the forthcoming healthcare reforms are causing uncertainty regarding the future funding of staff costs – on top of the long-running hospital reform and the shift towards outpatient care. This could also affect the international recruitment of nursing staff.

One of the reasons for this reluctance lies in the structural changes envisaged for the coming years by the new “GKV-Beitragssatzstabilisierungsgesetz”. The reform package, approved in July 2026, presents hospitals with far-reaching strategic decisions and budgetary challenges: The cap on future growth in the nursing budget requires an adjustment to staffing plans, even though the actual demand for nursing staff remains high in many places. But what are the consequences of this development for the international recruitment of nursing staff? And what does it mean for Germany as a destination country for labour migration?

We discussed this with Petra Lütkewitte, Managing Director of Careloop KLETT and MEDWING International.

Demographic change presents the German healthcare system with a twofold challenge: on the one hand, more and more employees are leaving the labour market due to retirement, whilst on the other hand, the need for nursing and medical care is rising as the population ages. Nevertheless, many hospitals are currently cautious about taking on new staff.

“We are already seeing a slowdown in recruitment this year due to the ongoing hospital reforms. The current reform packages, comprising the “GKV-Beitragssatzstabilisierungsgesetz” and the planned “Pflegeneuordnungsgesetz (PNOG)”, have certainly worsened the situation, and many hospitals are planning significant cuts to recruitment by 2027. It remains to be seen how quickly this will change, as the needs – which persist despite budget cuts – simply cannot be met. Some experts anticipate a slowdown in labour migration only for the coming year; others foresee ongoing budget constraints over the next 2–3 years. In any case, there is a great deal of uncertainty,” explains Petra Lütkewitte.

The consequence could be that hospitals align their staff planning in the short term with financial constraints, whilst the long-term need for nursing staff remains. This creates a tension between economic pressure and staff shortages, which is also likely to influence international recruitment.

Does a cautious staffing policy also mean that Germany will need fewer international nursing staff in the long term?

Petra Lütkewitte distinguishes between the fundamental staffing requirements and the changes within the healthcare system: “I think that whilst the fundamental and long-term demand in hospitals is being reduced by hospital reforms and the shift towards outpatient care, we will still not be able to manage without international recruitment in this sector either.”

Furthermore, the shift of certain services from the inpatient to the outpatient sector could change staffing requirements in individual parts of the healthcare system. At the same time, demographic change remains a key factor: many care workers are reaching retirement age, whilst the demand for care in an ageing society is rising.  “The baby-boomer effect cannot be met by graduates of training programmes, and in the medium term we anticipate a steady demand for 20–30, 000 skilled workers from abroad per year, and a large proportion of training places are already being filled by trainees from abroad or holding foreign passports,” says Petra Lütkewitte, referring to the strategic observations and analyses of the KLETT Group.

It will therefore be crucial to see how demand for care staff develops across hospitals, outpatient services and other areas of care. A change in staffing requirements at individual clinics does not automatically mean that Germany as a whole will be less reliant on international skilled workers.

However, even a temporary reduction in international recruitment could have long-term consequences. After all, there are often months or even years between the recruitment of a nursing professional abroad and their actual deployment in Germany. This includes, amongst other things, language acquisition, the visa process, entry into the country and professional recognition.

If recruitment processes are significantly scaled back in 2027, this could therefore have a delayed impact on the supply of staff. Fewer new hires would not only reduce the number of arrivals in the short term, but could also lead to fewer international care workers taking up employment in Germany in the years that follow, or even preparing themselves abroad – through the preliminary processes – for placement in Germany.

Petra Lütkewitte is warning of precisely this effect: “If recruitment is carried out only very cautiously in 2027, it will take time to restart the processes afterwards, and this will initially result in significantly fewer arrivals and new starters in 2028, followed by recognition in 2028/29.”

Additional pressures and capacity bottlenecks may arise if care workers are required in future to take on tasks that were previously handled by support services. This could further increase their workload. ‘Politicians are also running the risk here that more care workers will leave the profession, making the shortfall even greater,’ says Petra Lütkewitte.

This creates the risk that short-term savings will lead to new staffing shortages in the long term. Precisely because international recruitment and recognition take time, lost recruitment cohorts cannot be easily replaced at short notice.

Alongside the question of future recruitment, there is also the question of what impact the reform will have on international care professionals who have already come to Germany or are preparing to enter the country.

For professionals already in employment, Petra Lütkewitte does not foresee any immediate consequences, provided that the recognition procedures continue and are completed, and there are no redundancies for operational reasons. However, there is a particular risk for international care workers on probation whose professional recognition has not yet been finalised.

“Of course, there is still a risk for care workers on probation, who would be particularly vulnerable in the event of redundancy because they have not yet completed the recognition process and their residence permit is linked to their employer,” she explains.

But it is not only international care workers already in employment who could be affected by financial uncertainties. Particularly problematic are cases where hospitals no longer wish to, or are unable to, allow already recruited skilled workers to enter the country despite existing employment contracts, and terminate the employment contract even before they arrive.

“This is a phenomenon that is simply unfair and should not be allowed to happen: We have heard of some institutions that are no longer allowing already recruited skilled workers to ‘enter the country’ because they are facing budget constraints. Whilst we fully understand economic difficulties, this cannot and must not be at the expense of care workers who, with a German employment contract, have been preparing to enter the country for months or even years,” emphasises Petra Lütkewitte.

For the care workers affected, this can mean that, despite months or even years of preparation, they are initially left without the career prospects they had expected. Finding new employers at short notice is often not immediately possible given the state of the market, as there are hardly any vacancies, and even fewer that are suitable.

Petra Lütkewitte hopes that employers will at least refrain from taking such steps on a large scale. Consultations on this matter are planned within the framework of the Quality Association for the Recruitment and Placement of Nursing Staff from Abroad (GAPA) and, if necessary, also with the Federal Ministry of Health (BMG), should such cases now become more frequent.

How financial uncertainty actually affects nursing staff who have already immigrated and those planning to do so will depend largely on how hospitals adapt their staffing plans to the new circumstances.

The effects of a cautious recruitment policy could go beyond individual medical facilities. Germany is competing with other destination countries to recruit international nursing staff. In addition to the political framework of migration policy, the reliability of career prospects and entry procedures also plays a role here.

The decision by hospitals to withdraw announced vacancies or to postpone the entry of already selected professionals could undermine the confidence of potential applicants. At the same time, countries of origin and local recruitment agencies could focus more strongly on other destination countries in future.

Petra Lütkewitte already sees this as a real challenge: “The sudden reduction in the number of international skilled workers will have many consequences in the countries of origin. Many service providers and local as well as German agencies have now launched language courses and programmes, yet the current cohorts will no longer be able to find jobs at all, meaning that applicants and their countries of origin will essentially have to turn their attention to other destination countries.”

For the recruiters affected, such a development means that they may invest time and money in language courses and preparation for employment in Germany without being able to achieve the career prospects originally promised. This will pose significant financial challenges for many agencies, particularly smaller ones, which in turn will also increase the financial risk for employers, for example in the event of future claims for recourse. Germany, for its part, may find it more difficult to maintain the recruitment structures it has already established in the long term.

How much the healthcare reform will actually affect the international recruitment of nursing staff depends on the further implementation of the legal requirements and the reactions of hospitals. Short-term cautiousness in hiring new staff does not necessarily mean a permanent decline in demand. However, it could lead to recruitment processes being interrupted, arrivals being postponed and urgently needed skilled staff only becoming available after a considerable delay.

At the same time, demographic trends and the reorganisation of healthcare are changing the demand for nursing staff. International recruitment is therefore likely to continue to play an important role in the future – though possibly with a shift in focus between different areas of care.

For Germany, this means that not only the financing of the healthcare system is under review, but also the reliability of its recruitment structures. After all, attracting international skilled workers requires long-term planning, stable framework conditions and mutual trust. If recruitment processes that have already begun are called into question at short notice, the consequences could extend far beyond individual hospitals.

The key challenge will therefore be to combine financial stabilisation with reliable staff planning. Otherwise, there is a risk of a paradoxical situation arising: whilst the demand for nursing and medical care continues to rise, it is precisely the uncertainties surrounding funding that could result in urgently needed skilled workers arriving in Germany later than planned – or not at all.