Employers Propose Major Reforms to Statutory Health Insurance Model

The Federation of German Employers' Associations (BDA) has put forward a comprehensive set of recommendations aimed at restructuring the financial framework of Germany's statutory health insurance (GKV). The proposals, outlined in a recent policy paper, primarily target cost reduction and increased revenue for health insurance funds, with the goal of reducing both insurance contributions and ancillary wage costs for employers and employees alike.

At the center of these recommendations is a call to revise the longstanding solidarity principle of the statutory health insurance system, specifically the rules surrounding family coverage. Currently, spouses without or with only minimal income can be co-insured free of charge under a family member's policy. The BDA suggests introducing a mandatory minimum monthly contribution of approximately 220 euros for these individuals. According to their estimates, this adjustment could generate an additional 2.8 billion euros in annual revenue for the health insurance funds.

Another significant recommendation is the reintroduction of a fee for physician consultations. Unlike the previously abolished quarterly practice fee, the BDA proposes a new 'contact fee' to be charged at each medical appointment, rather than per quarter. The intent is to promote more judicious use of healthcare services. Alongside this, the BDA advocates for issuing patients a detailed billing statement after each visit, which would be automatically integrated into their electronic health records, thereby increasing transparency around healthcare costs and services rendered.

The BDA also supports reducing the value-added tax on pharmaceuticals and medical aids to seven percent. The association questions the rationale behind higher taxation on medicines compared to products such as confectionery or pet supplies, suggesting that a reduced tax rate on health-related products is both logical and socially equitable.

A key aspect of the BDA's proposed reforms involves redefining the scope of services covered by statutory health insurance. The association recommends focusing on providing a basic level of healthcare coverage to ensure essential medical needs are met, while excluding services deemed non-essential or discretionary. This could include, for example, limiting coverage for certain high-cost treatments for elderly patients. The criteria for what constitutes 'basic coverage' remain to be clearly defined, but the overarching principle is that only treatments with proven benefit and cost-effectiveness should be reimbursed through the statutory insurance system.

The BDA's proposals echo similar ideas discussed previously by policymakers in the Federal Ministry of Health, including suggestions for evidence-based limitations on reimbursable services. The association argues that by strictly focusing on necessary and economically justified treatments, the statutory health insurance system could achieve significant savings--potentially up to 50 billion euros annually under optimistic forecasts.

The policy paper also highlights the need for greater transparency within the healthcare sector. By providing patients with clear information about the costs and nature of services received, and by integrating this data into electronic patient records, the BDA believes patients will be better equipped to make informed decisions regarding their healthcare.

These proposals are expected to spark significant debate among stakeholders, as they challenge established principles of solidarity and universal access that have characterized Germany's healthcare landscape for decades. As the government prepares to consider further healthcare reforms, the employers' association's recommendations are likely to influence ongoing discussions about the future structure and funding of statutory health insurance in Germany.