The German Health Minister, Nina Warken of the CDU, has unveiled a sweeping healthcare reform plan poised to significantly alter patient access to specialist care, sparking immediate debate and raising concerns about potential consequences for both patients and the medical profession. At the core of the proposed overhaul is the dismantling of the currently unrestricted right to directly access specialist physicians. Speaking to the Frankfurter Allgemeine Zeitung, Warken stated, “A major reform of primary care is planned. It will no longer be possible for everyone to directly access specialists, nor to as many doctors as they currently desire.
The intention, according to the Minister, is to streamline the system and curtail costly, redundant treatments. General practitioners will be designated as the primary point of contact, acting as gatekeepers who then facilitate referrals to specialists, contingent upon a guaranteed appointment based on demonstrated medical necessity.
A key element of the reform introduces a financial incentive for adherence to this referral system. Patients bypassing their GP and seeking direct access to specialists risk incurring additional fees. Furthermore, the government may refuse to reimburse treatments deemed inappropriate or unnecessary by primary care physicians, placing the financial burden directly on the patient. To alleviate the pressure on GPs, the plan also proposes enhanced training and expanded responsibilities for medical administrative staff.
Warken aims to present a draft bill for review before the summer recess, with implementation slated for 2028. This initiative forms part of a broader strategy to address the precarious financial standing of the German healthcare system. An independent commission tasked with assessing the statutory health insurance system is expected to deliver reform proposals by the end of March. Warken anticipates annual savings of double-digit billions of euros beginning in 2027, requiring a comprehensive review across all sectors — hospitals, physicians and pharmaceuticals — to eliminate inefficiencies and instances of double remuneration.
The Minister expressed confidence that her proposed reforms will mitigate escalating healthcare costs, recently impacting policyholders. She predicts, “I expect a total of stable contributions for 2026”. While acknowledging potential, localized adjustments in supplemental contributions from individual health insurance funds, she asserted, “We assume that there will be no further increases”. Warken has framed her success as Minister as intrinsically linked to maintaining the stability of health and long-term care insurance contributions throughout her tenure, a politically sensitive target given ongoing public anxiety about affordability.
Critics, however, have already raised concerns regarding the potential for longer wait times for specialist appointments, the impact on patient autonomy in healthcare decisions and the fairness of financially penalizing individuals seeking specialized care. The proposed changes represent a significant shift in the established healthcare model and are likely to face considerable scrutiny and opposition as they progress through the legislative process.
