A government-appointed expert commission on Monday released a 66-point package designed to curb the steady rise in health-insurance contributions paid by Germans. The 480-page report is meant as a “well-filled toolbox” of options for policymakers, Federal Health Minister Nina Warken (CDU) said, adding that any reforms should not unduly burden insured people or undermine the system’s solidarity.
Germany’s health care system is among the most expensive in the world. State health insurers alone currently spend about €1 billion per day on care, a figure expected to grow. Contributions to those public insurers increased by roughly 3% this year after a 2.5% rise in 2025. The state insurers’ association (GKV) produced a projection cited by the commission that the gap between insurers’ income and spending could widen from €15.3 billion in 2027 to €40.4 billion by 2030 if current trends continue.
The commission, made up of 10 specialists in economics, medicine and social law, assembled many recommendations because the government is unlikely to adopt every proposal for political reasons. Major measures highlighted in the report include:
– Raising taxes on spirits and tobacco.
– Introducing a levy on sugary drinks; the commission noted that similar taxes abroad have prompted producers to reduce sugar content.
– Requiring an independent second opinion from a doctor with no financial interest before planned operations (for example, knee replacements), pointing to Germany’s comparatively high rates of such procedures.
– Increasing patient co-payments for prescription drugs, where insurers currently cover most costs.
– Ending automatic family coverage for spouses of breadwinners who have no children under six — a suggestion that has already drawn opposition from some regional leaders.
– Transferring responsibility for the health care costs of unemployment-benefit recipients to the federal budget rather than to health insurers — a move estimated to save insurers about €12 billion annually but likely to be politically contentious amid broader spending trade-offs.
Eugen Brysch, chair of the German Foundation for Patient Protection, said the ideas in the report are not new but are now collected in one place and urged the government to pick a clear path. He warned that measures such as shifting costs for the unemployed to the federal budget could ignite political conflict within the coalition.
Context: Germany runs a dual system funded by employee and employer contributions. Health insurance is mandatory; roughly 90% of people are covered by state insurers that must accept everyone, while about 10% opt for private plans. Critics say current payment incentives for hospitals and doctors can encourage expensive or unnecessary treatments, driving up costs and insurers’ contribution rates.
Next steps: Warken said her ministry will review the commission’s recommendations quickly and prepare a draft bill to present to the Cabinet by summer. Edited by Rina Goldenberg.