(de-news.net) – As funding cuts threaten to increase wait times, German politicians, health insurers and physicians are pressing for changes to specialist appointment scheduling. Proposals range from a binding three-week appointment guarantee and needs-based allocation to a broader restructuring of medical primary care. At the same time, the European Commission has raised concerns that planned digital booking rules could disadvantage private platforms, adding a competition dispute to the wider debate over access to medical services and the financial sustainability of statutory health insurance.

Politicians from the Christian Social Union (CSU) and Social Democratic Party (SPD) are calling for measures to address disparities in specialist appointment waiting times. Klaus Holetschek, leader of the CSU parliamentary group in Bavaria, has proposed reconsidering whether online booking platforms should be permitted to ask patients about their insurance status.

Thorsten Frei, parliamentary leader of the Christian Democratic Union (CDU), has also called for changes. Although he acknowledged the advantages of Germany’s dual public-private insurance system, he conceded that some aspects were perceived as unfair or were inequitable in practice. CDU Health Minister Carsten Linnemann is expected to develop proposals addressing the problem. Chancellor Friedrich Merz (CDU) had previously warned that long waits for patients covered by statutory insurance, contrasted with faster access for privately insured people, raised broader questions of social justice.

SPD proposes a binding appointment guarantee

As part of a broader reform of primary care, the SPD has proposed a legally binding guarantee of specialist appointments. Christos Pantazis, the party’s health policy spokesperson, called for patients to receive appointments within three weeks, or sooner when medically necessary. If an outpatient practice could not meet that deadline, a suitable hospital outpatient department would take over treatment.

The proposed patient-centered primary care system would also strengthen general and pediatric practices, improve coordination among providers and expand interdisciplinary cooperation. Digital preliminary assessments and appointment services would support these changes. Patients would retain the freedom to choose their primary care physician and direct access to selected specialists, including gynecologists and psychotherapists. The SPD opposes practice fees and financial penalties, arguing that better services should encourage participation in the reformed system.

Lina Seitzl, the SPD legislator responsible for the policy area, emphasized the importance of general practitioners and pediatricians as patients’ first points of contact. Their practices would coordinate treatment more effectively with other qualified professionals, supported by expanded interdisciplinary cooperation within and beyond primary care settings.

Health insurers call for needs-based appointment allocation

The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) has advocated a centralized, regularly updated booking platform through which all practices would make a fixed proportion of their appointments available. Its chairman, Oliver Blatt, noted that approximately 75 million people have statutory insurance and finance the overwhelming majority of physician fees, yet frequently encounter difficulties securing appointments. He argued that medical need, rather than insurance category, should determine how appointments are allocated. Blatt rejected the broader characterization of Germany’s health care system as two-tier medicine, maintaining that most physicians and hospitals provide patients with equally good treatment. In his assessment, the principal disparity lies in waiting times rather than the quality of medical care.

Jens Baas, head of Techniker Krankenkasse, has advocated replacing Germany’s dual insurance structure with a new system combining the strengths of both models. The Social Association of Germany (SoVD) has likewise called for needs-based care without multiple tiers. Its chairwoman, Michaela Engelmeier, welcomed Merz’s acknowledgment of the problem and urged the government to address existing disparities. She also called on Frei to honor his commitment to ensuring that patients do not have to wait months for specialist treatment.

Physicians warn that funding cuts could worsen shortages

Physicians’ representatives warn that the government’s measures could further aggravate existing capacity constraints. Andreas Gassen, chairman of the National Association of Statutory Health Insurance Physicians (KBV), expects waiting times for patients covered by statutory insurance to increase substantially from next year. He argued that cuts to outpatient funding had effectively removed more than 50 million appointments from the system.

Gassen also questioned whether requiring practices to report a fixed number of available appointments would improve access. Reserving slots for centralized allocation could leave fewer appointments available to patients already receiving care at those practices, he warned. In his assessment, expanding funding for outpatient services is necessary to increase capacity and accommodate demand.

EU questions proposed rules for digital booking platforms

The European Commission has separately challenged the government’s plans to reorganize digital appointment scheduling, warning that the proposed Health Data and Digital Innovation Act (GeDIG) could disadvantage private booking platforms. Under the draft legislation, the KBV and the GKV-Spitzenverband would establish technical and other requirements for services such as Doctolib and Jameda. The Commission has raised concerns about potential conflicts of interest because the KBV also operates the 116117 appointment service. According to a letter cited by media outlets, the Commission wants the rules to be established impartially and transparently, with appropriate safeguards against conflicts of interest. It has also criticized provisions governing the proposed digital entry point to care, which would allow patients to book appointments through their electronic patient record app.

Although the draft calls for open and competition-neutral conditions, the Commission argues that the proposed system appears to rely exclusively on the KBV’s booking infrastructure without clearly providing for private platforms to participate. The dispute therefore extends beyond appointment availability to the organization of digital services and the conditions under which public and private providers compete.

Parliament is currently considering the GeDIG proposal. The KBV reports that its 116117 service arranged approximately two million appointments last year, while Doctolib says its platform is used by 30 million people in Germany.