The proportion of income German medical practices derive from statutory health insurance (Kassenabrechnung) has plummeted to a record low of 67.0 percent in 2023, according to data released by the Federal Statistical Office (Destatis). This marks the lowest level since comprehensive nationwide data collection began in 2000, signaling a potentially significant shift in the structure of the German healthcare system.
The trend reflects a gradual decline observed in recent years, with a corresponding rise in income generated from private billing. In 2022, practices averaged 71.1 percent of revenue from statutory insurance, dwindling to 71.7 percent in 2021. Private billing accounted for 28.0 percent of income in 2023, a considerable jump from 24.3 percent in 2022. This shift raises concerns about potential inequities in access to care, as private billing often entails higher costs for patients.
A contributing factor to this evolution is the accelerating rise of exclusively private practices. In 2023, 6.5 percent of surveyed practices reported generating no income through statutory health insurance, compared to 5.4 percent in 2022 and 3.8 percent in 2021. This proliferation of private practices alongside the increasing reliance on private billing within practices that also accept statutory insurance, underscores a potential market-driven stratification of care.
The data reveal striking variations across medical specialties. Fields like dermatology and sexually transmitted diseases, orthopedics and trauma surgery and surgical specialties witness a significantly heavier reliance on private billing, with over half of their revenue derived from this source. Conversely, general practitioners (GPs), neurologists and pediatricians obtain a much smaller portion of income from private sources, highlighting potential disparities in reimbursement rates and patient demographics.
The situation within dental practices is also revealing, with a lower overall reliance on statutory insurance compared to medical practices and a marked decrease in this dependence observed over the last year. The notably higher proportion of income from private billing within dental practices, coupled with the wider trend across medical practices, warrants scrutiny regarding the impact on affordability and equitable access to dental care.
Interestingly, practices focused on psychotherapy maintain the highest dependency on statutory health insurance, with 88.7 percent of revenue originating from this source. However, even within this sector, a subtle shift towards private billing is detectable.
The dramatic decline in reliance on statutory health insurance across various medical fields inevitably triggers broader political questions. Concerns are mounting about the sustainability of the current statutory health insurance system, the potential for a two-tiered healthcare system and the ability of the system to cater for the needs of all German citizens. Some experts suggest that the data provide further evidence of an unsustainable reimbursement model for primary care physicians, potentially driving practitioners towards private billing to compensate for limited statutory payouts, effectively impacting patient choice and ultimately, access. Government intervention and potential reforms to reimbursement policies may be required to address these emerging imbalances.
