Gesundheit: Kassenbeiträge bleiben stabil – aber der Druck auf Linnemann wächst

The contribution rates in statutory health insurance (GKV) are expected to remain stable next year according to the GKV estimator circle. Minister Carsten Linnemann (CDU) declared that they had achieved their main goal at the announcement of the forecast on Wednesday evening. For contributors at first, this is a reason to breathe easier, but experts warn that the effects may only be short-term.

They also propose more profound reforms to stabilize contributions in the long term. The estimation result shows an average contribution rate of unchanged 2.9% for 2027. The GKV estimator circle is an expert group consisting of members from the Federal Office for Social Security, the Ministry of Health, and the GKV top association.

They have been advising and issuing a forecast for contribution development each year. For the current year, expenditures are expected to rise by nearly seven percent. Next year, the increase is now predicted to fall below three percent, according to the ministry. Overall, healthcare expenditures in statutory health insurance are expected to be 370 billion euros in 2026, rising to 378 billion euros the following year.

Individual insurers set their contributions for the upcoming year, currently ranging from 2.18 to 4.39% among 93 insurers. The DAK notes that with the estimator circle's result, the chances for stable contributions in 2027 have not become any smaller. However, it is too early to make a decision. Contributions are stable for now The contributions have increased significantly in recent years.

The average additional contribution rate has doubled since 2022, from 1.3% to 2.9%, and could continue to rise in the medium term. The health ministry's reform package so far focuses on expenditure cuts for the coming year and dampening measures until 2030. The health insurance budget remains strained. Verena Bentele, president of the social association, calls the estimation only "a short break".

Many insurers reacted similarly. A Deloitte study, exclusively provided to the Handelsblatt, shows drastic cost increases in the coming years: Without more profound reforms, the deficit is expected to grow from the foreseen 19 billion euros next year to around 117 billion euros by 2035, costing average contributors an additional 471 euros per year.

The cost increase would be higher if modern technologies were accelerated. What reforms should follow? Boris Augurzky, health economist at the Leibniz Institute for Economic Research in Essen, critically looks at the measures taken by the health ministry so far and the Contribution Stabilization Act. "The whole law was intended to cut, these are not particularly clever measures.

They needed them to stabilize the system temporarily, however." He primarily sees a challenge: The austerity measures were a kind of "hot potato" that the insurers, among other things, dumped onto the clinics. "I wish we wouldn't simply pass the hot potato back and forth." Linnemann is aware of the short-term nature of his planned cuts and announced: "We must solve the structural problems of the statutory health insurance and provide its financing with a solid foundation in the long term."

The health ministry's financial commission is due to present proposals for medium and long-term structural reforms in the healthcare sector by the end of the year. In their first report at the end of March, the experts had already presented 66 short-term measures, including mainly efficiency gains and a quantitative reduction in perceived services, such as health prevention.

"Our health system must be turned upside down to ensure modern medicine for all statutory insureds," says Gregor-Konstantin Elbel, author of the Deloitte study. His study shows how reforms could not only prevent an increase in contributions but even relieve contributors. Bentele also calls for reducing contributions instead of stabilizing them, stating it is what people truly need.

But it is already clear how difficult it is to implement structural reforms. The sugar tax decided on Wednesday was discussed extensively, with soft drinks also being added. While this would have increased tax revenues for the finance ministry, it lost its health policy purpose - namely to give companies an incentive to reduce the sugar content in drinks.

Augurzky holds the measure overall as sensible. However, it should be implemented without exceptions to fulfill its purpose, he says. The planned cut to the pharmaceutical industry's rebates also faces criticism. The industry has reacted alarmingly, warning of its competitiveness being jeopardized and pulling investments out of Germany.

The government then backed down, which in turn caused criticism from the insurers. "The government has made financial concessions to certain performance sectors that now have to be financed again through other measures," criticized Ulrike Elsner, managing director of the association representing the largest insurers in Germany. The DAK also expresses dissatisfaction: "If the pharmaceutical area is to be relieved by 1.3 billion euros now, it must not come at the expense of contributors."