Germany’s statutory health insurance funds are calling for structural reforms amid growing financial pressures. Representatives stated Tuesday in Berlin that the system is increasingly absorbing responsibilities traditionally falling to the state, leading to a situation where contributions are used to cover broader governmental tasks.
The funds reported a deficit of €6.2 billion in the fourth quarter of 2024 and currently project a shortfall of €46 billion for the current year. Eighty-eight of the 94 health insurance funds are increasing additional contributions, with further increases anticipated. This will translate to a reduction in net pay for employees and increased costs for employers, particularly within the small and medium-sized enterprise sector.
Officials argue that relying solely on loans to address the deficit is a misrepresentation of the situation, effectively turning contributors into borrowers while simultaneously subsidizing the state budget.
A recent Forsa survey commissioned by a leading association of health funds revealed a significant shift in public perception. Sixty-five percent of respondents now identify high contribution rates as one of the most pressing issues facing the healthcare system, up from 46 percent last year. The survey also indicated strong support, with 82 percent of respondents, for dedicated use of contributions exclusively for benefits to members.
Satisfaction with health policy is currently at a low point, with only 28 percent of citizens expressing satisfaction or high satisfaction – a decrease from 39 percent in 2024. Concerns are particularly pronounced among individuals aged 45 to 59, who bear a substantial share of the financing burden, with 74 percent expressing dissatisfaction.
In response, the associations are advocating for three immediate measures. These include full and cost-covering financial support from tax revenues for individuals receiving basic income support, a critical review of spending increases that do not demonstrably improve care and a moratorium on spending until the recommendations of an expert commission are available and implemented.
They also emphasize the need for responsible financing of services not directly linked to insurance coverage, arguing that these should be funded from general tax revenue. The federal subsidy, they point out, has remained unchanged since 2017.
Proposed reforms include incorporating new income and business models, such as digital platform work, into the contribution system. Additionally, they suggest earmarking a portion of revenues from sin taxes – an estimated €17 billion annually from tobacco and alcohol – to the health insurance funds.
On the expenditure side, they call for strengthening oversight and audit rights in areas such as hospital billing and procurement, while also promoting evidence-based decisions regarding covered services. Strengthening primary care is also highlighted as a means to reduce waiting times and improve access to care.
