According to a recent study by the Scientific Institute of the AOK (WIdO), statutory health insurance is projected to incur excess expenditure of 360 million euros in 2025, primarily due to a new regulation of fee-for-service payments that was intended to reduce costs.
This analysis, obtained by the “Frankfurter Allgemeine Zeitung” (Thursday edition), indicates that while the policy aims to shift operations from hospitals to outpatient practices, the new regulation has unintentionally spurred a significant rise in surgical numbers-affecting procedures like hernia repairs or gallbladder stone removal, among others.
Carola Reimann, the Chairwoman of the AOK Federal Association, is now demanding a correction to the statutory compensation guidelines for these specific operations. Reimann told the “FAZ” that the reform, which was enacted by the traffic light coalition in 2024, was “well-intentioned but poorly executed.” She stressed that the legislator must improve these regulations immediately.
Since 2024, these case-based lump sum payments (Hybrid-DRGS) have resulted in equal compensation rates for certain interventions, whether provided by contracted doctors or hospitals. While this caused hospital revenue to decrease, compensation for contracted doctors increased sharply. The original goal was to ensure more treatments occurred outpatient rather than inpatient, as this is theoretically more cost-effective. However, the Wido study found that the overall number of cases subsequently increased by 17 percent. Consequently, Reimann is advocating for a 30 percent reduction in these case lump sums to prevent such volume effects that lead to increased costs for statutory health insurance funds.
