Germany’s statutory health insurance system faces growing financial pressure, prompting debate over potential reforms and cost-saving measures. Experts are increasingly warning that maintaining current funding levels will require significant adjustments, potentially impacting contributions and patient access.
Health economist Wolfgang Greiner has proposed increasing patient co-payments for prescription drugs as one possible solution. Currently, insured individuals contribute between five and ten euros per prescription. Greiner suggests adjusting these co-payments for inflation, potentially doubling or tripling the amount, which could generate additional revenue of around 2.5 billion euros annually. He notes this could also lead to some lower-priced medications falling outside of coverage if co-payments exceed their price.
The discussion follows a recent report from Germany’s Federal Audit Office highlighting the financial instability within the statutory health insurance system. While the federal government initially proposed supporting the system with loans, several stakeholders, including Health Minister Nina Warken and representatives from the AOK health insurance fund, argue this is insufficient. Warken and Greiner both contend that loans only postpone the problem, as repayment would likely necessitate contribution increases without a significant economic upturn. They advocate for direct subsidies from the federal budget, potentially tied to non-insurance-related benefits.
Calls for broader structural reforms are also gaining momentum. Katharina Schenk, chairwoman of the Conference of Health Ministers, described the Audit Office report as a “wake-up call” urging a fundamental restructuring of the system to ensure its long-term financial viability. Proposals under consideration include raising the contribution assessment ceiling and streamlining non-insurance benefits.
Carola Reimann, CEO of AOK, echoed concerns about the lack of progress in controlling healthcare spending and improving efficiency. She stressed the need for a paradigm shift in health policy, emphasizing that sustainable stability requires aligning expenditures with revenue and preventing a widening gap between contributions and benefits. Minister Warken plans to convene an expert commission to develop reform proposals for the statutory health insurance system.
