German doctors debate added fees to ‘no-show’ appointments

With up to 20 percent of doctors' visits missed in Germany, physicians are asking whether a penalty fee could prevent the problem and create more appointment availability for everyone.

German doctors debate added fees to 'no-show' appointments
A doctor's appointment in Buchow, Bavaria. Photo: DPA

Missed doctors appointments throughout Germany are “quite a problem”, Andreas Gassen, the head National Association of Statutory Health Insurance Physicians (KBV), told DPA.

No-shows throughout the Bundesrepublik vary between five and almost 20 percent of all scheduled doctors’ visits, according to a KBV study of 1,000 doctor practices.

SEE ALSO: Everything you need to know about making a doctor's appointment in Germany

“There are always reasons why patients don't come,” Gassen said. Sometimes patients will purposely “hoard” several dates to ensure that they can make it to one, he added.

If appointments are booked in advance and a patient doesn’t show up, an especially large problem is created, he said – in particular, if, for example, an outpatient operation was planned, and staff and resources were allocated for that time slot.

A fee for no-shows?

The NAV-Virchow-Bund (Association of Physicians in Private Practice) is advocating cancellation fees for such cases – especially when a specific procedure is planned.

“[No shows] cause real economic damage to the practices,” said chairman Dirk Heinrich. “With the signal of such a fee,” doctors are ensuring the patients cancel their appointments in advance or make it on time, he added.

Some doctors' public practices already warn patients that they will have to pay a fee is they miss an appointment without cancelling it in advance. But because there is no set law in Germany on such fees, this varies from practice to practice.

“If your doctor actually charges you a fee for a missed appointment, he should clearly inform you of the cancellation fee when making the appointment,” writes Germany's consumer advice centre

The association of statutory health insurances (GKV) rejects added costs for patients, however. In the agreements on physician reimbursements, extra fees for times of no-show patients are already taken into account, said GKV vice chairman Johann-Magnus von Stackelberg.

“Doctors who ask patients to pay a penalty fee will thus earn double,” said Johann-Magnus von Stackelberg, Vice-Chairman of the GKV-Spitzenverband (the GKV's umbrella organization).

'In a waiting room for eternity'

He added that doctors, too, need to give more thought about how to make it to their own appointments on time.

“Precisely because patients, in spite of an appointment, always feel like they are sitting in a waiting room for an eternity, doctors should first take a close look at themselves when it comes to adherence to appointments,” said Stackelberg.

The GKV stated in December that public patients have a shortage of times to chose from, with many practices closed in the early evenings, the weekends and part of the day on Wednesday and Friday.

About 85 percent of people in Germany rely on public health insurance.

SEE ALSO: What you need to know about the complicated world of German health insurance


Member comments

Log in here to leave a comment.
Become a Member to leave a comment.
For members


Why more than 20 million people in Germany face higher health insurance costs

Several German health insurance companies have raised their rates this year, pushing up the costs for customers.

Many people are facing higher health insurance contributions this year.
Many people are facing higher health insurance contributions this year. Photo: picture alliance / dpa | Jan Woitas

According to a study by the comparison portal Check24, around 21 million people with statutory health insurance (gesetzliche Krankenversicherung or GKV) have had to pay higher contributions since the beginning of the year after several organisations raised their additional contributions. 

A total of 19 of the 97 statutory health insurance providers in Germany have increased their additional contributions, the comparison portal found.

It means more than a quarter of the 73 million people with statutory health insurance in Germany have to pay higher additional contributions. 

According to Check24, the higher additional contributions can cost an insured person in the most expensive case an extra €261 per year.

Among those to have raised their additional contributions include AOK Baden-Württemberg and AOK Bayern, which have both increased the additional contributions from 1.10 percent to 1.30 percent. Check24 has published the full list of additional contributions here.

Customers affected receive a letter in the post letting them know when their contributions are increasing. Health insurance providers justify raising their rates by pointing out rising costs in the health and care system. The pandemic has also put significant strain on providers. 

READ ALSO: How to make the most of reward schemes on your German health insurance

A total of 67 health insurance providers are keeping their individual additional contribution the same. And as many as 11 health insurance funds lowered their contributions – although most of these already had comparatively high rates.

In 2021, Techniker Krankenkasse (TK), the largest statutory health insurance fund in Germany with around 8.2 million members, raised its additional contribution significantly.

The contribution went up to 1.2 percent from 0.7 percent. Average earners saw additional monthly costs of about €10 extra, while self-employed people had to pay up to €288 more per year. 

TK has not raised its rates this year. 

Can you switch health insurance?

If your health insurance company increases the additional contribution, those insured have a special right of termination until January 31st, 2022.

They can apply for the change up until this date, and they will then become a member of the new health insurance provider from April 1st after the statutory two month change-over period has expired.

Insured people also have the right to change their statutory health insurance fund every 12 months.

The cost of public health insurance in Germany is a fixed salary percentage of 14.6 percent, while the reduced contribution rate for employees without entitlement to sick pay is 14.0 per cent.

Beyond that, however, health insurance providers set an additional contribution.

The contribution assessment ceiling for statutory health insurance (GKV) – up to which contributions are levied – remains unchanged at €58,050 per year in 2022, as in the previous year.

Check24 said that switching providers can save employees up to €624 per year depending on their income.

Self-employed people pay both the employee and employer contribution and can therefore save up to €1,248 euros per year by switching, the analysis found. 

However in a representative YouGov survey only 11 percent of respondents in Germany said they had recently changed their insurance provider or would do so in the foreseeable future.

Most of the benefits provided by statutory health insurance organisations are identical.

READ ALSO: EXPLAINED: The three new services covered by German health insurance

However, there are some differences in the voluntary benefits, including dental health (professional dental cleaning and discounted dentures), vaccinations (flu vaccinations for under 60s and travel vaccinations), various cancer screening examinations and osteopathic treatments.

“In addition to the financial relief, insured people can also secure higher subsidies for professional dental cleaning or other additional benefits by switching,” said Dr Daniel Güssow, Managing Director of statutory health insurers at Check24.


Additional contributions (die) Zusatzbeiträge

Right of termination – (das) Kündigungsrecht 

Benefits (die) Leistungen

We’re aiming to help our readers improve their German by translating vocabulary from some of our news stories. Did you find this article useful? Let us know.