German employers are pushing for radical and potentially disruptive reforms to Germany’s statutory health insurance (GKV) system, proposing savings that could reach as high as €50 billion annually, according to calculations by “Frankfurter Allgemeine Zeitung (FAZ)”. The proposals, detailed in an unpublished position paper from the Confederation of German Employer Associations (BDA), represent a significant challenge to the current model and spark concerns about access and equity within the healthcare system.
At the heart of the proposals is a fundamental restructuring of contribution responsibilities. Employers are advocating for the elimination of free coverage for spouses with minimal income, who would now be required to pay a minimum contribution of approximately €220 per month. This single measure alone is projected to generate an additional €2.8 billion annually for health funds. Further, the BDA seeks to reinstate a modified version of the abolished “practice fee” – now dubbed a “contact fee” – which would be charged for “every” doctor’s visit, rather than the previous quarterly rate. The employers argue this would discourage unnecessary consultations, potentially saving up to €3 billion annually.
Beyond contribution changes, the BDA is pushing for a reduction in Value Added Tax (VAT) on pharmaceuticals and medical aids from the current rate to 7%, a move predicted to unlock savings of €5.3 billion. They argue the current tax rate on medications is disproportionately high compared to other consumer goods. A further, unprecedented proposal involves the introduction of a “patient receipt” for every treatment, automatically integrated into electronic patient records, ostensibly to increase transparency but also raising concerns about data privacy and potential misuse.
The cumulative impact of these measures, according to FAZ’s calculations, could reduce annual GKV expenditures by 10%, potentially lowering contribution rates for both employers and employees from the current average of 17.5% to between 15.5% and 16%. This level hasn’t been seen in two decades. For employees earning close to the contribution assessment limit, potential savings could range from €41 to €55 per month.
BDA President Rainer Dulger defends the proposals, stating that the issue isn’t a lack of funding but a misallocation of resources. He emphasizes the need for “sustainable structural reforms” and highlights the proposals submitted to the “Finance Commission for Health”, a committee established by Health Minister Nina Warken, charged with developing reform proposals by March 2026.
Critics are already voicing concerns that these reforms prioritize cost-cutting over accessibility and equity. The proposals risk placing an undue burden on lower-income households and could, ultimately, undermine the core principle of solidarity that underpins the German healthcare system. The debate promises to be contentious, with significant political and social implications as Germany grapples with the future of its healthcare model.