A proposal for a new supplementary insurance option is being considered as a response to ongoing discussions surrounding improved patient guidance and increased cost-sharing within the German healthcare system. Andreas Gassen, Chairman of the Association of Statutory Health Insurance Physicians (KBV), has introduced this alternative to the government’s currently planned reforms.
The suggested “specialist tariff” estimated to cost between €200 and €350 annually, would allow insured individuals to continue accessing specialists directly, bypassing the requirement for a referral from a general practitioner or digital initial assessment. This addresses concerns regarding the government’s proposed model, which prioritizes referrals from primary care physicians, particularly benefiting older individuals with complex health conditions.
Gassen acknowledged the value of the government’s approach for certain patient groups but emphasized that it may be perceived as unnecessary for younger individuals. He stressed that the specialist tariff would preserve patient choice and direct access to specialist care.
Individuals referred to specialists by their general practitioner or recommended through digital initial assessments would not be required to pay the additional tariff. Gassen clarified that medical necessity would continue to dictate the urgency of specialist appointments in those instances.
The KBV Chairman argued that the current system, heavily reliant on cost controls, effectively limits specialist appointment availability. He suggested that a financial incentive for specialists, generated through the tariff income, could encourage them to offer more appointments. These additional funds would be specifically allocated to compensate for the increased workload and currently insufficient reimbursement rates for specialist services.
While acknowledging previous suggestions to impose a fixed fee of €200 for each direct specialist visit, Gassen deemed the amount excessive, noting that the statutory health insurance costs for a specialist appointment typically range between €60 and €75.
