The German Health Minister, Nina Warken of the CDU, has unveiled a sweeping healthcare reform plan that is likely to significantly alter patient access to specialist medical care, sparking immediate controversy and raising questions about the sustainability of Germany’s renowned social healthcare system. In an exclusive interview with the Frankfurter Allgemeine Zeitung, Warken detailed a proposed restructuring of primary care, effectively curtailing direct access to specialists for many patients.
At the core of the proposed changes lies a reinforced role for general practitioners (GPs) as the mandatory first point of contact. Patients seeking specialist treatment will increasingly require a referral, with the GP acting as a ‘gatekeeper’ to ensure appropriate and necessary consultations. While specialists will be guaranteed appointment availability based on medical necessity, bypassing this referral system could now incur additional costs for patients and potentially render treatments unreimbursed.
“Patients adhering to the referral system could receive a financial bonus” Warken stated, suggesting a potential incentive structure. “Conversely, those seeking specialist care without a referral may be subject to fees and medically necessary services not aligned with primary care recommendations risk being passed on to the patient’s direct financial responsibility.
This shift in healthcare delivery is presented as a critical component of a broader effort to address the strained financial state of the German healthcare system. An independent commission tasked with assessing the statutory health insurance system is expected to deliver reform proposals by the end of March, with Warken anticipating annual savings exceeding ten billion euros by 2027. A comprehensive package encompassing hospital funding, physician compensation and pharmaceutical pricing is being considered, targeting inefficiencies, redundancies and perceived “perverse incentives” within the system.
The proposed legislation, slated for presentation as a draft bill before the summer recess and implementation in 2028, has already drawn criticism from patient advocacy groups who express concern over potential barriers to timely specialist care. The restriction on direct access to specialists has prompted accusations of rationing care and potentially exacerbating existing inequalities in healthcare access.
Warken, however, defends the reforms as essential for long-term stability, projecting that the changes will contribute to stable health insurance contributions by 2026, albeit with the possibility of isolated individual insurance funds increasing supplemental contributions. Critically, she has declared her personal assessment of her ministerial tenure will be tied to the stability of these contributions, placing significant pressure on the reform’s success and raising concerns about the potential impact on patient choice and access to specialized medical services. The government’s ability to deliver on these promises while maintaining public trust in Germany’s healthcare system remains to be seen.