The German statutory health insurance (GKV) system is teetering on the brink of crisis, with escalating costs and a looming political storm threatening its stability. Anne-Kathrin Klemm, head of the Association of Public Health Insurance Funds (AOK), has launched a scathing critique of current hospital billing practices and broader systemic failings, warning of a potential tipping point by 2026.
Central to Klemm’s concerns is the abuse of “pflegebudget” or nursing care budgets, introduced in 2020 to address staffing shortages and ensure adequate patient care. Hospitals now receive unlimited funding per patient based solely on the number of nursing staff employed, irrespective of their actual workload or qualifications. Klemm accuses hospitals of exploiting the system, alleging that some are assigning nurses to tasks like floor cleaning instead of patient care and employing unqualified personnel solely to generate billable hours. She has called for the complete abolition of this budget mechanism, deeming the current situation “fraud.
The unsustainable cost increases are placing immense strain on the GKV. Existing contribution rates, already exceeding the 2.9% target set by Health Minister Nina Warken (CDU) for 2026, currently stand at an average of 17.7%. Klemm predicts further rate hikes later this year if the government fails to intervene, a prospect exacerbated by Warken’s recently proposed relief package, dismissed by Klemm as “peanuts” and deemed insufficient to address the systemic issues.
The situation extends beyond hospitals. Klemm highlighted the precarious state of the care insurance sector, propped up by temporary federal loans to avoid immediate contribution increases – a solution she believes merely postpones inevitable future crises. She anticipates potential liquidity crises and bailouts for care funds as early as the summer or fall.
Beyond financial reforms, Klemm is advocating for broader policy changes, including a reduction of the Value Added Tax (VAT) on pharmaceuticals to 7% from 19% and federal government assumption of the full cost of basic income support (Bürgergeld) contributions, equaling approximately 10 billion euros annually. She underscored the urgency of the situation, warning that if decisive action isn’t taken, healthcare and care reforms will be unattainable within the current legislative period.
The looming political landscape adds further complexity. Klemm expressed concern that the far-right Alternative for Germany (AfD) will capitalize on public dissatisfaction with the healthcare system and leverage the ongoing crisis for populist electoral gains. She urged mainstream political forces to prioritize healthcare and care policy to counter this threat.
Klemm also rejected proposed measures like reducing the number of health insurance funds or introducing co-payments, criticizing them as generating unnecessary bureaucracy and frustration. Instead, she proposed innovative solutions such as a tax on highly processed, unhealthy foods and a sugar tax. Finally, she advocated for mandatory health education in schools, arguing that statutory limitations currently restrict preventative care initiatives offered by health insurance funds, hindering proactive health advice and early intervention for conditions like diabetes and cardiovascular disease.
