Germany’s health insurance system is struggling, despite the country spending more on health than almost any of its European neighbours.
Germany's Statutory Health Insurance (GKV) system is under pressure from rising healthcare costs brought about in part by higher hospital treatment expenses, an ageing population and the growing prevalence of chronic diseases.
As Germany’s coalition government debates measures designed to stabilise the financing of healthcare in the short-term, an increasing number of government figures and commentators argue the country’s health insurance system needs fundamental change.
What is the problem?
In 2024, healthcare expenses per insured individual in Germany rose by 7.7 percent compared to 2023. As a consequence, the health ministry increased the average supplementary contribution rate for statutory health insurance (GKV) by 2.5 percent in 2025, representing an increase of 0.8 percent for insured individuals and their employers.
The result is higher year on year costs and, at the same time, a growing shortfall in funding.
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How is the government planning to plug the gap?
Health Minister Nina Warken of the centre-right Christian Democrats (CDU) has responded to the problem with a series of reform proposals.
Currently subject to political negotiations and expert committee reviews, and due to be finalised next year, these proposals are expected to include:
- Introducing a “base tariff” for statutory health insurance. Essentially, this means allowing insurers to offer a low-cost basic package, with optional add-ons for extra services.
- Reviving plans for a primary care physician model, whereby patients would be incentivised to consult their family doctor before seeing a specialist.
- Accelerating digitalisation in healthcare, including the expansion of electronic patient records and e-prescriptions.
- Allowing pharmacies to play a greater role in patient care, such as dispensing certain prescription drugs under clear legal regulations and offering more preventive services.
The Basic Tariff proposal
One of the most discussed ideas is the introduction of a basic tariff for statutory health insurance. Under this model, every insurer would offer a low-cost base package, with patients able to purchase additional coverage modules for an extra fee.
READ ALSO: The check-ups you can get in Germany with statutory health insurance
Charging fees for doctor’s visits
Another controversial suggestion is the introduction of fees for doctor’s visits. The Federal Government’s Drug Commissioner, Hendrik Streeck, has said that “we must move away from a mentality of comprehensive insurance that lacks solidarity. Health is not an all-inclusive service provided by the state.”
Streeck points out that Germans visit the doctor almost 10 times a year on average – far more than in Denmark or France – and believes that a fee could help reduce unnecessary visits and relieve pressure on the system.
According to an OECD study from 2020, people in Denmark and France visit the doctor 3.8 times and 5.5 time a year on average respectively. The figure for Germany is 9.6 visits on average.
Steffen Kampeter, managing director of the Confederation of German Employers’ Associations, has also called for a contact fee for each visit to the doctor, aiming to limit “doctor hopping” and keep insurance premiums stable.
READ ALSO: How to speed up getting a doctor's appointment in Germany
How would these charges work?
Andreas Gassen, head of the National Association of Statutory Health Insurance Physicians (KBV), has proposed a special fee for patients who visit specialists directly without a referral. Speaking to the Redaktionsnetzwerk Deutschland, he estimated the cost at between €200 and €350 annually.
Meanwhile, Albert Stegemann, deputy chairman of the CDU parliamentary group in the Bundestag,
supports a fee of €200 per specialist appointment when patients bypass the primary care system, according to Bild.
Several individuals and organisations have already come out against the idea of charging consultation fees. Lower Saxony’s Health Minister Andreas Philippi (SPD) calls the measure “anti-social and completely the wrong way to manage patient flows”.
Nicola Buhlinger-Göpfarth, chairwoman of the Association of General Practitioners, argues that a general consultation fee would “prevent not only unnecessary but also essential doctor visits”, with potentially serious health consequences if illnesses are treated too late or preventive measures are missed.
Health expert Ilias Essaida of the social welfare association VdK went argued against the proposals in stronger terms. “It is an unacceptable and toxic proposal by employers to shift the cost burden even more heavily onto the hard-working population,” he told Redaktionsnetzwerk Deutschland.
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