A commission of experts on Monday unveiled a 66-point plan aimed at reducing the steadily rising health insurance contributions Germans pay into the system.
Germany’s health care is among the world’s most expensive. State health insurers alone spend about €1 billion ($1.15 billion) per day on care — a figure forecast to grow. Meanwhile, contributions to those state insurers rose by roughly 3% this year, on top of a 2.5% increase in 2025. The commission highlighted a GKV (state insurers’ association) graphic showing the gap between insurers’ income and spending widening from €15.3 billion in 2027 to €40.4 billion in 2030 at current trends.
Closing the health care expenses gap
The 10-member commission — including specialists in economics, medicine and social law — was tasked with producing many recommendations because the government is unlikely to adopt all of them for political reasons. The 480-page report is intended to offer a “well-filled toolbox” of measures to be chosen from, Federal Health Minister Nina Warken (CDU) said, stressing reforms should not unduly burden the insured or undermine solidarity in the system.
Major proposals in the report include:
– Raising taxes on spirits and tobacco.
– Introducing a tax on sugary drinks; members noted other countries’ experience shows manufacturers often reduce sugar content after such taxes.
– Requiring an independent second opinion from a doctor with no economic interest before carrying out plannable operations (for example, knee replacements), citing Germany’s comparatively high rates of such procedures.
– Increasing patient co-payments for prescribed drugs, where insurers currently cover most costs.
– Ending automatic insurance coverage for spouses of breadwinners who have no children under six — a controversial idea opposed by some regional leaders.
– Shifting responsibility for the health care of unemployment-benefit recipients to the federal government rather than health insurers, a move the commission estimates would save insurers about €12 billion annually, though it may face political resistance amid broader budget-cutting efforts.
Eugen Brysch, chair of the German Foundation for Patient Protection, said the proposals were not new but scattered across various health organizations’ records; now it’s on the government to adopt a clear plan. He warned that measures such as transferring care costs for the unemployed to the federal budget could spark political conflict within the coalition.
The ins and outs of the German health care system
Germany operates a dual system funded by employee and employer contributions. Health insurance is mandatory and state insurers — covering around 90% of the population — cannot refuse anyone. Roughly 10% choose private insurance, which often offers more extensive coverage.
Critics have long argued that payment incentives for hospitals and doctors can encourage expensive or unnecessary treatments, contributing to insurers’ rising costs and higher contributions for the insured.
Next steps
Health Minister Warken said the commission’s recommendations will be reviewed quickly and her ministry will prepare a draft bill to present to the Cabinet by summer.
Edited by Rina Goldenberg