German Health Minister Nina Warken (CDU) has presented a reform package designed to stabilise the country’s public health insurance system and prevent further rises in contribution rates. The draft legislation, expected to reach the cabinet in the coming weeks, aims to close a growing funding gap in the Gesetzliche Krankenversicherung (GKV) without immediately raising contribution rates.
Background and fiscal pressure
Health insurance is compulsory in Germany; roughly 90% of residents are covered by the income-dependent public scheme. Contributions amount to about 14.5% of wages, split between employers and employees, plus a small insurer-specific premium. Contribution rates have been rising recently — around +3% this year after a 2.5% increase in 2025 — while insurers’ costs have climbed even faster. If no savings are found, statutory health funds face a projected shortfall of more than €15 billion by 2027.
Main measures announced
Warken said the government will adopt several measures from an expert commission’s list of 66 proposals. Key elements announced include:
– Higher prescription co-payments, raised to between €7.50 and €15 (up from the previous €5 to €10 range).
– Mandatory independent second opinions for costly hip and knee operations, delivered by physicians who do not profit from performing the surgery.
– From 2028, spouses without their own income who are currently covered free of charge will pay a flat contribution set at 3.5% of the insured partner’s income. The charge will be reduced for low- and middle-income households, and exemptions will apply for those caring for young children, parents of children with disabilities, caregivers and pensioners.
– Homeopathic treatments will no longer be reimbursed by statutory health insurance.
– Stronger, mandatory discounts will be required from pharmaceutical companies.
– New caps on executive pay and tighter limits on administrative and advertising spending within the system.
– Removal of certain extra-budgetary payments to family doctors, including special fees for walk-in consultation hours and payments linked to patient referrals.
Reactions
The Greens criticized the package as insufficient, saying it shifts too much burden onto workers and employers while leaving powerful spending lobbies largely intact. Janosch Dahmen, the Greens’ health policy spokesperson, argued the plan does not go far enough to rein in rising healthcare costs.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) welcomed Warken’s emphasis on tying insurer spending to revenues. The association noted that statutory funds now spend more than €1 billion per day to cover roughly 75 million people, with recent year-on-year increases of nearly 10% in hospital spending, almost 8% in doctors’ costs and about 6% in drug expenditures.
Not included: welfare cost shift
Warken’s package stops short of the commission’s largest single-saving recommendation: shifting the health insurance costs for welfare recipients onto the federal budget, which was projected to save insurers roughly €12.5 billion in 2027. That proposal was reportedly blocked after pressure from Finance Minister Lars Klingbeil (SPD), who threatened to veto such a move.
Next steps
The cabinet will consider the draft in the coming weeks, after which the bill is expected to go to the Bundestag and the Bundesrat for parliamentary debate and votes before the summer recess. If adopted, the measures would be phased in over the next several years, with some changes taking effect from 2028.