A 10-member commission of experts this week presented a 66-point, 480-page plan aimed at reducing rising health insurance contributions and closing a growing financing gap in Germany’s health system.
Why change is needed
Germany’s health care is among the world’s most expensive. State health insurers alone spend roughly €1 billion per day on care, and expenses are rising faster than contributions. Insured workers saw average contribution rises of about 3% this year on top of a planned 2.5% increase in 2025. The insurers’ association (GKV) projects the shortfall between income and expenses will grow from €15.3 billion in 2027 to €40.4 billion by 2030 if current trends continue.
About the commission
The 10 experts—drawn from economics, medicine and social law—were tasked with producing an extensive set of proposals so the government could select politically feasible measures. Federal Health Minister Nina Warken (CDU) said the report offers a “well-filled toolbox” and stressed reforms should not one-sidedly burden the insured or undermine solidarity in the system.
Key proposals
The commission’s recommendations mix revenue measures, cost controls and structural changes. Highlights include:
– Higher taxes on spirits and tobacco.
– A new tax on sugary drinks to incentivize manufacturers to reduce sugar content.
– Requiring independent second opinions for plannable operations (e.g., knee replacements) to curb potentially unnecessary surgeries; Germany performs more such operations than many EU peers.
– Increasing patient co-payments for prescribed drugs, shifting some costs from insurers to patients.
– Ending automatic insurance for spouses of breadwinners who have no children under six — a controversial move already opposed by some regional leaders.
– Transferring responsibility for covering the health care costs of unemployment-benefit recipients from insurers to the federal government, a change the commission says would save insurers about €12 billion annually.
Reactions and politics
Patient-rights advocate Eugen Brysch of the German Foundation for Patient Protection said many proposals are familiar to specialists but emphasized the need for a clear government plan. He warned that measures such as shifting costs for the unemployed would trigger political disputes within the coalition. Bavaria’s Markus Söder has already rejected the proposal to remove automatic spousal coverage.
System context
Germany operates a dual, mandatory insurance system funded by employee and employer contributions. About 90% of the population are in statutory (state) health insurance, which must accept all applicants; roughly 10% choose private insurance. Critics have long argued that payment and hospital incentives can promote costly or unnecessary treatments, inflating insurers’ bills and pushing up contributions.
Next steps
Health Minister Warken pledged a rapid review and said her ministry would prepare a draft bill for Cabinet consideration by the summer. The commission deliberately offered many options so the government could choose politically acceptable reforms from its “toolbox.” The challenge will be selecting measures that close the financing gap without undermining the system’s solidarity or provoking major political conflict. Edited by Rina Goldenberg