Health Minister Nina Warken (CDU) has firmly rejected proposals to restructure Germany’s statutory health insurance system into a tiered model, comprising a basic coverage package and optional supplementary tariffs. In an interview with the Redaktionsnetzwerk Deutschland, Warken defended the principle of solidarity underpinning the current system, arguing that access to medical care should not be contingent on an individual’s income.
Responding to questions about potential “red lines” in the planned financial reform of the health insurance system, Warken stated that creating a “rump tariff” with minimal coverage alongside supplementary insurance options would be a dangerous shift. She warned that such a system would effectively introduce a form of two-tiered medicine, where the quality and speed of care are dictated by affordability. “It’s a system we have achieved, a solidary system and one I don’t want to give up” she declared, emphasizing the importance of maintaining equitable access for all citizens.
The urgency of the reform is being driven by looming financial pressures. Warken explicitly warned of a projected deficit exceeding ten billion euros by 2027, a shortfall that must be addressed. The widening gap between income and expenditure within the system shows no signs of abating. A key component of the proposed reforms is the introduction of a primary care physician pathway system, designed to direct patients toward general practitioners before referral to specialists.
Warken acknowledged the need for incentives to encourage adherence to this pathway, suggesting options such as bonus payments for patients who remain within the general practitioner network or additional fees for those who bypass it and directly consult specialists. This attempt to manage patient flow has been met with resistance, particularly following suggestions from the Chairman of the Association of Statutory Health Physicians, Andreas Gassen, advocating for a separate specialist tariff for those wishing to avoid the mandated pathway. Warken dismissed this proposal outright, stating that the goal is to improve overall patient care, not to allow individuals to “purchase unnecessary or inappropriate services”. Ultimately, she stressed the commitment to a “system for all” while also insisting that everyone requiring specialist consultations must receive them within a reasonable timeframe.
