(de-news.net) – Broad resistance has mounted to the National Association of Statutory Health Insurance Physicians’ (KBV) proposal to introduce a per-visit fee. The proposal has triggered significant debate within both the health and social policy communities. Opponents from major patient advocacy organizations, including the German Foundation for Patient Protection, argued that the initiative appeared designed less to improve clinical outcomes than to expand revenue streams for providers and insurers. They contended that substantial public resources were already being allocated to services they regarded as only marginally adequate, raising concerns that an additional charge would merely deepen preexisting inefficiencies. Representatives from the social-welfare sector added that such a fee structure would have disproportionate effects on low-income groups, who might delay necessary consultations due to financial barriers—potentially aggravating health conditions and generating higher long-term costs for the system. They contended that the proposed approach would neither stabilize healthcare financing nor incentivize systemic reforms, and instead would externalize institutional shortcomings onto individuals seeking care.
The political reactions reflected similar lines of critique. SPD health policy maker Christos Pantazis described the proposal as socially regressive and practically ineffective, framing it as an approach that would neither improve equity nor meaningfully influence care utilization patterns. Green Party health spokesperson Janosch Dahmen likewise argued that a practice fee would primarily inflate administrative demands—through billing, verification, and exemption procedures—rather than strengthening system performance. Both lawmakers observed that the idea strongly resembled earlier cost-containment strategies from the 2000s that had largely failed to generate sustainable improvements or structural modernization within Germany’s healthcare architecture. On his part, Ates Gürpinar, a spokesperson for the Left Party Bundestag on health economics, stated that a per-visit cost would not address the health insurers’ financial issues. Rather, he contended, it would mostly drive sick and impoverished people out of the solidarity-based system.
Despite these objections, the KBV leadership continued to defend the plan, insisting that a modest ‘“’contact fee,’ assessed at approximately three to four euros per visit and collected directly by insurers, could broaden the financial base of the statutory health-insurance system. KBV chair Andreas Gassen maintained that the contribution could be designed in a socially equitable fashion, asserting that carefully calibrated exemptions or caps would prevent undue hardship while still expanding revenue flows. From the KBV’s perspective, such an instrument could help counteract the mounting fiscal pressures that have confronted insurance funds in recent years.
Further criticism nevertheless mounted, particularly from SPD representatives who argued that shifting additional financial responsibility onto patients would undermine solidarity, one of the core principles of Germany’s statutory insurance model. Patient organizations echoed this position, asserting that the proposal would offer little tangible benefit for those who most frequently rely on outpatient services.
Amid this broader debate, Federal Patient Commissioner Stefan Schwartze (SPD) called for the discontinuation of individualized health services (IGeL) that require out-of-pocket payment. He argued that many of these services lacked a sufficient evidence base but continued to expand in scope, creating a growing market for procedures that were neither clinically necessary nor scientifically validated. Schwartze also highlighted recurring complaints from insured individuals who reported that access to appointments was sometimes implicitly conditioned on accepting IGeL offerings—an arrangement he insisted must not occur in statutory care. Statutory insurers have similarly and repeatedly questioned the medical value of numerous IGeL services, which remain outside standard benefit coverage and must therefore be paid for entirely by patients.
