Health Insurers: Costs for Health and Long-Term Care Insurance 'Getting Out of Hand' - Germany's health insurance crisis demands urgent reforms by 2027

Germany's statutory health insurance system faces a growing financial crisis. Without major reforms, a funding gap of over €10 billion is expected by 2027. Industry leaders and the government are now pushing for urgent changes to control rising costs and improve efficiency.

The Association of Substitute Health Funds (vdek) has warned of unsustainable spending in both health and long-term care insurance. At the same time, Health Minister Nina Warken has proposed sweeping reforms to stabilise the system and streamline patient care.

The financial strain on Germany's health system is becoming more severe. By 2026, total health insurance spending is projected to hit a record €370 billion. Long-term care costs alone could reach €80 billion within the same period. These figures have prompted warnings from vdek about spiralling expenses unless immediate action is taken.

In response, Health Minister Nina Warken recently met with industry representatives to discuss primary care reforms. A key proposal is the introduction of a gatekeeper model, where patients must first consult a general practitioner before seeing specialists. This change aims to reduce unnecessary visits and lower costs. The reform also includes a mandatory primary care system, with implementation set to begin in late January 2026. vdek has backed Warken's plans but insists on additional measures. The association is calling for stricter controls on spending, ensuring it aligns with revenue growth. It also wants improved healthcare management, including digital tools like online initial assessments, electronic referrals, and a centralised appointment platform. These steps are intended to make doctor visits more efficient and accessible. To ease financial pressure, vdek has proposed reducing VAT on medications and introducing cost-neutral financing for unemployment benefit recipients. The goal is to prevent further strain on the system while maintaining essential services for all patients. Beyond primary care, Warken's broader reform package includes hospital restructuring, emergency care improvements, and pharmacy sector changes. These measures are designed to create a more sustainable and patient-focused healthcare system.

The proposed reforms aim to close the funding gap and prevent future shortfalls. If implemented, stricter spending controls, digital healthcare tools, and a gatekeeper system could reshape how patients access medical services. The government and industry groups will need to work closely to ensure these changes take effect before costs rise further.