(de-news.net) – The Federal Government is advancing a broad reform of statutory health insurance aligned with expert commission proposals, aiming to generate substantial cost savings through benefit restrictions, higher co-payments, and structural financing changes. Parallel debates address emergency medication dispensing rights, insurer consolidation, tobacco tax allocation, and pharmacy remuneration, reflecting intensified efforts to contain rising healthcare expenditures while balancing competing stakeholder interests and systemic stability. As the CDU General Secretary has called for a major consolidation of statutory health insurers, the announced tobacco tax increase has triggered a debate over equitable revenue allocation, and pharmacists are seeking higher remuneration.
A government-appointed expert commission’s proposals are closely aligned with the Federal Government’s broader agenda to comprehensively restructure statutory health insurance. Following coalition consultations in Berlin, Chancellor Friedrich Merz stated that the recommended measures would be incorporated into forthcoming draft legislation and implemented to the fullest extent feasible within the political and fiscal constraints. Over the next year, the reform package is projected to generate savings of nearly $42 billion for the health system, reflecting its central role in ongoing efforts to stabilize public health financing and contain rising expenditure pressures.
The recommendations encompass a range of cost-containment and restructuring measures, including tighter limits on orthodontic care, mandatory second medical opinions for elective surgical procedures, and the removal of homeopathic treatments from the statutory benefits catalog. In parallel, the proposals call for increased patient co-payments for pharmaceuticals, higher excise duties on alcohol, tobacco, and sugar-sweetened beverages, and a structural realignment in which the federal government would assume full responsibility for insurance contributions for recipients of unemployment-related benefits. Taken together, these measures are framed as mutually reinforcing components of a broader strategy aimed at reducing systemic inefficiencies, curbing expenditure growth, and ensuring longer-term fiscal sustainability within statutory health insurance.
In addition to these core reforms, a separate but related initiative under consideration would expand the operational scope of emergency medical practice within out-of-hours care settings. A draft proposal prepared under Health Minister Nina Warken (CDU) would authorize physicians working in after-hours medical facilities to dispense medication directly to patients in narrowly defined emergency scenarios. This provision, explicitly limited to short-term treatment needs of up to three days and excluding controlled substances, is intended to facilitate more immediate access to essential medicines in situations where public pharmacies are not readily accessible. The measure is designed as a carefully circumscribed exception to the established separation between prescribing physicians and dispensing pharmacists—a regulatory principle intended to prevent conflicts of interest in medication provision—and would apply only where no nearby pharmacy is available. Nevertheless, the Federal Union of German Associations of Pharmacists (ABDA) has cautioned that such an approach could risk undermining the established pharmacy infrastructure and potentially encourage parallel supply channels.
Linnemann calls for major consolidation of statutory health insurers
In parallel, CDU General Secretary Carsten Linnemann has intensified calls for a substantial consolidation of statutory health insurers within wider structural reform discussions, arguing that the current fragmentation of the system contributes to persistent inefficiencies and disproportionately high administrative costs despite broadly uniform benefit structures. He has proposed reducing the more than 90 existing insurance funds to approximately ten and introducing stricter minimum membership thresholds to phase out smaller insurers. These remarks were accompanied by criticism of what he views as insufficiently effective competitive mechanisms within the system, as well as calls for more ambitious cost-containment measures that go beyond the scope of current reform initiatives. By contrast, the head of the GKV-Spitzenverband rejected the debate as disconnected from practical implementation realities, while the Federal Health Ministry continues to advance savings-oriented reforms in response to an anticipated budget shortfall exceeding $10 billion in the current fiscal year.
Fiscal policy discussions are also being shaped by a coalition agreement between the governing parties that foresees an increase in tobacco taxation, which has become a focal point of broader distributional debates. Medical professional organizations, including the Association of General Practitioners in Germany under its chair Nicola Buhlinger-Göpfarth, have expressed support for higher tobacco taxes on public health grounds but argue that the resulting revenues should be explicitly earmarked for preventive services and medical treatment rather than redirected toward unrelated fiscal objectives. At the same time, coalition planners intend to allocate a portion of the additional tax revenue to offset costs associated with a proposed tax-exempt employee relief payment, linking health-related taxation to wider budget consolidation efforts.
Within the pharmaceutical sector, the ABDA has simultaneously pressed for a more substantial increase in pharmacy remuneration than that currently envisaged by the government. ABDA President Thomas Preis has argued that existing compensation structures have failed to keep pace with sharply rising operating costs over the past decade and therefore require reform through a more dynamic, periodically negotiated adjustment mechanism comparable to the system used for medical fee-setting. He further maintained that, when accounting for cumulative cost developments over recent years, a significantly higher per-dispensed-package reimbursement level than currently proposed would be economically justified.
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