Germany’s statutory health insurance system is facing increasing financial strain, with providers urging structural reforms to address mounting deficits and declining public confidence. Recent data indicates a deficit of 6.2 billion euros in the fourth quarter of 2024 and projections for the current year forecast a shortfall of 46 billion euros.
In response, 88 of 94 health insurance funds are increasing supplementary contributions, with further increases anticipated. This translates to a reduction in net income for employees and increased pressure on wage costs for employers, particularly within small and medium-sized businesses.
Industry representatives argue that reliance on loans to cover deficits is a misrepresentation of the situation, effectively turning contributors into debtors while simultaneously subsidizing the state budget. This practice is described as financially questionable and a breach of trust for those who fund the healthcare system.
A recent survey reveals a significant shift in public perception. 65% of respondents now identify high contribution rates as one of the most pressing issues facing healthcare, compared to 46% last year. The survey also demonstrates strong support – with 82% approval – for earmarking contributions exclusively for benefits for members of the statutory health insurance system.
Correspondingly, satisfaction with health policy has fallen to a low point, with only 28% of respondents expressing satisfaction or high satisfaction, down from 39% last year. Notably, dissatisfaction is particularly acute among the 45-59 age group, who bear a significant burden of the system’s financing, with 74% expressing discontent.
To address the escalating situation, health insurance funds are proposing three immediate measures. First, they call for complete and cost-covering funding of healthcare for recipients of basic income support from tax revenues, rather than continuing to draw on health insurance funds. Second, they advocate for critical review of statutory expenditure increases that do not demonstrably improve care. Third, they call for a moratorium on expenditure until the findings of an expert commission can be translated into political reform.
The industry also emphasizes the need for responsible financing of services that fall outside the scope of insurance coverage – currently funded by contributions despite being the responsibility of the state. They point to a lack of increase in federal subsidies since 2017, arguing that the state must fulfill its obligations and avoid cross-subsidizing the federal budget with social security contributions.
Reform proposals include integrating new forms of work, such as digital platform employment, into the solidarity-based financing model and earmarking a portion of state revenues from sin taxes – estimated at 17 billion euros annually from tobacco and alcohol – to the health insurance system.
On the expenditure side, they advocate for strengthening oversight and auditing rights and prioritizing evidence-based decision-making regarding the services covered by the insurance system. They also stress the importance of strengthening primary care to reduce waiting times and improve access to healthcare.