A 10-member expert commission this week released a 66-point, 480-page package intended to slow rising health insurance contributions and close a growing financing gap in Germany’s health system.
Why change is urgent
Germany’s health care is already one of the most expensive in the world. Statutory insurers spend roughly €1 billion per day on care, while costs are outpacing income. Insured workers faced average contribution increases of about 3% this year, on top of a planned 2.5% rise in 2025. The Association of Statutory Health Insurance Funds (GKV) warns the deficit between revenues and expenses could widen from €15.3 billion in 2027 to €40.4 billion by 2030 if nothing changes.
About the commission
The panel of 10 specialists—from economics, medicine and social law—was asked to assemble a broad set of policy options so the government can pick politically viable reforms. Federal Health Minister Nina Warken (CDU) described the report as a “well-filled toolbox,” stressing that any reforms must avoid unduly shifting burdens onto the insured or eroding system solidarity.
Key recommendations
The commission blends revenue measures, cost controls and structural shifts. Major proposals include:
– Raising taxes on spirits and tobacco.
– Introducing a tax on sugary drinks to push manufacturers to cut sugar.
– Requiring independent second opinions for planned operations (for example, knee replacements) to reduce potentially unnecessary surgeries; Germany performs more of these procedures than many EU peers.
– Increasing patient co-payments for prescription drugs to transfer some costs from insurers to patients.
– Ending automatic family insurance for spouses of breadwinners who do not have children under six, a controversial step already opposed by some regional leaders.
– Shifting responsibility for covering health costs of unemployment-benefit recipients from insurers to the federal government, which the commission estimates would save insurers about €12 billion per year.
Reactions and politics
Patient-rights advocate Eugen Brysch said many of the proposals are familiar to specialists but warned the government needs a clear, implementable plan. He and others cautioned that measures such as reallocating costs for the unemployed will spark political fights inside the governing coalition. Bavaria’s Markus Söder has publicly rejected removing automatic spousal coverage.
System context and next steps
Germany runs a dual mandatory system funded by employee and employer contributions: about 90% are in statutory insurance, which must accept all applicants, while roughly 10% opt for private insurance. Critics argue that payment rules and hospital incentives can encourage costly or unnecessary treatments, driving up insurers’ bills and contributions.
Warken has promised a rapid review and said her ministry will prepare a draft bill for Cabinet consideration by summer. The commission intentionally provided many options so the government can choose measures that close the financing gap while preserving solidarity and avoiding major political rupture.