For Per Kistenbrügge, caring for pregnant women is part of everyday life. The gynecologist from Hanover regularly examines his patients during pregnancy. For this he receives money from the health insurance companies, outside of the limited practice budget.
This should fundamentally change from 2027. As part of the Statutory Health Insurance Contribution Rate Stabilization Act, numerous services that were previously paid for additionally are to be included again in the so-called morbidity-related total remuneration, or MGV for short. Many of the services provided by practicing physicians are already paid for from this limited budget.
Gynecologist fears problems with more patients
Kistenbrügge fears that future income will not develop in proportion to actual needs. “As it can be read, at least at this point in time, we will receive funds that correspond to the year 2025 and not to current needs,” he explains. "That means, for example, if I looked after 50 pregnant women in 2025 - I'll say a fictitious number - then I will have the money for 50 pregnant women in 2027."
His concern: If additional services are no longer fully reimbursed, practices could take on fewer patients.
Health insurance companies: No money is lost
However, the National Association of Statutory Health Insurance Funds contradicts the impression that the previous remuneration for prenatal care will be canceled. The money will be completely transferred to the MGV. “As a result of this legal requirement, in 2027 there will be no less euro available for early detection and preventive examinations than before,” says spokesman Florian Lanz. The total compensation will also continue to be increased annually. However, how much it will increase in the coming year is still the subject of negotiations.
The National Association of Statutory Health Insurance Funds considers the legislature's fundamental intention to control care more closely and thereby strengthen overall remuneration to be understandable.
AOK does not rule out lower remuneration
The AOK Lower Saxony argues similarly. She also emphasizes that the money previously earmarked for the affected services will be retained from 2027. The health insurance company currently does not see any threat to the care of pregnant women. However, the AOK cannot completely rule out the financial impact of increasing demand: if more gynecological services are provided in the future, these may only be reimbursed proportionately. However, the AOK does not expect such a development. She points to the declining number of births in Lower Saxony.
The Lower Saxony Medical Association argues against this. It is not clear whether the development of patient numbers in the practices is the same.
Doctors' representatives doubt whether the budget is sufficient
Johannes Neimann, gynecologist and board member of the Lower Saxony Medical Association, also believes it is possible that the search for a gynecologist's practice will become more difficult if financing actually leads to restrictions.
The National Association of Statutory Health Insurance Physicians therefore considers the concerns of gynecologists to be justified. According to their assessment, it will be difficult to sufficiently increase the MGV's financial framework. She accuses the health insurance companies of “purely austerity measures” in the ongoing negotiations.
Pediatricians are also affected by savings plans
Pediatricians are currently in a similar situation: in the past, their services were actually largely budgeted for. With the new GKV Savings Act, this final budgeting will not be completely abolished from 2027, but according to the National Association of Statutory Health Insurance Physicians, it will be limited through the “back door”. Compensation payments should be paid in stages that go beyond the total compensation due to morbidity.
Exceptions still possible
How prenatal care will actually be reimbursed from 2027 has not yet been finally determined. The passed law does provide the new framework. However, the responsible evaluation committee can still determine that certain services are paid for outside the limited budget. The prerequisites for this include, among other things, advantages for quality of care and cost-effectiveness.
Per Kistenbrügge is particularly hoping for a solution for pregnant women. “My really fervent hope [is] that this budgeting doesn’t happen for pregnant women,” he says. The National Association of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Funds are currently negotiating the specific remuneration. A decision is expected by the end of September.
