(de-news.net) – As the Federal Government advances a broader restructuring of Germany’s physician-care system, Federal Health Minister Nina Warken of the CDU has emphasized the necessity of systemic compromise among medical stakeholders. In public remarks, she framed the reform effort as both difficult and unavoidable, arguing that longstanding structural inefficiencies could not be addressed without meaningful concessions from all professional groups involved. According to her assessment, physicians, pharmacies, and other actors within the health system would need to move beyond institutionally entrenched positions and engage constructively in negotiations, since durable reform would depend on shared responsibility and coordinated adjustment rather than unilateral changes.
Gatekeeping reform to streamline specialist access
A central element of the ministry’s reform agenda is the proposed introduction of a primary-care gatekeeping model designed to rationalize patient access to specialized treatment. Under this framework, patients would generally consult general practitioners as the initial point of care, with referrals ensuring timely specialist appointments when clinically justified. The ministry has presented this approach as a mechanism to strengthen coordination across care levels, reduce unnecessary specialist consultations, and improve overall resource allocation. In addition, the model would incorporate telephone- and digitally-based triage systems to support early clinical assessment and streamline patient pathways. Pharmacies are also expected to assume an expanded supportive function within this coordinated structure, thereby contributing to greater efficiency and accessibility. Warken indicated that draft legislation formalizing these changes is expected in the summer, with initial implementation focused on individuals covered by statutory health insurance, while policy arrangements applicable to privately insured patients remain under active consideration.
At the same time, Warken has clarified the government’s position regarding telephone-based sick leave certification, an issue that has generated debate within the political sphere. Although a recent party congress resolution by the CDU endorsed abolishing remote certification, she stated that the governing coalition currently has no plans to pursue such abolition. Instead, she pointed to the coalition agreement as establishing a more limited objective focused on restricting misuse associated with online sick leave platforms rather than eliminating remote certification entirely. In her view, concerns about improper use justified targeted regulatory safeguards, and she expressed confidence that coalition partners would support measures aligned with their negotiated commitments. This position reflects an effort to balance accessibility and flexibility in patient certification processes with safeguards designed to preserve system integrity.
Hospital consolidation one of the cores of minister’s reform strategy
Warken has also addressed criticism from medical associations concerning proposals to expand the clinical role of pharmacies. She rejected assertions that such changes would undermine medical standards, explaining that decisions regarding prescription authority and diagnostic scope would not be imposed unilaterally by policymakers. Instead, she indicated that clinical guidelines and operational parameters would be defined through joint professional bodies composed of both physicians and pharmacists, thereby ensuring that professional expertise and shared accountability shape implementation. Within this framework, pharmacies would continue to provide certain medications without prescriptions in cases involving uncomplicated acute conditions and would be authorized to administer selected vaccinations. These measures, she suggested, are intended to improve access to care while reducing administrative barriers, and she indicated that initial outcomes could begin to emerge within the current year as reforms take effect.
In parallel, Warken has identified hospital reform adjustments as an urgent legislative priority, with the objective of securing approval from both the Bundestag and the Bundesrat by the end of March. She indicated that achieving consensus between federal and state authorities would facilitate smoother implementation and reduce the likelihood of escalation to formal mediation mechanisms. Although federal states have requested additional exemptions and modifications, particularly regarding hospital financing arrangements and funding structures, she expressed confidence that negotiated compromises remain attainable. More broadly, she characterized structural transformation of the hospital sector as unavoidable, noting that consolidation and closures would likely form part of the adjustment process. While acknowledging that such developments may generate public concern and uncertainty, she framed them as necessary measures to ensure the long-term sustainability, efficiency, and functional viability of Germany’s hospital system within a changing healthcare environment.
