Berlin. When Friedrich Merz (CDU) spoke about the future of the health system a few days ago, the Chancellor took up a topic that the Union had long preferred to leave to the SPD: the differences between those with statutory and private insurance.
If private patients received services more quickly, but statutory health insurance patients had to wait weeks or months, that would be perceived as a “justice problem,” said Merz. He is not calling for the abolition of private health insurance, as his spokesman later explained.
But Merz had initiated a debate that goes far beyond the question of waiting times: How long can the separation between those with statutory and private insurance be justified in its current form?
Two Kiel economists from the renowned economic research institute Kiel Institute for the World Economy (IfW Kiel) are now suggesting a middle path. According to their idea, private health insurance (PKV) should remain, but high earners should be more involved in solidarity compensation.
Federal Health Minister Carsten Linnemann (CDU) also defended the dual system during a government survey: Citizens' insurance, as the coalition partner has been calling for for years, does not solve the cost problems, he said.
Jens Baas, head of the Techniker Krankenkasse, argues, similar to the economists from Kiel, for a fundamental debate and a new system that combines elements of both forms of insurance. “Anyone who only calls for the abolition of private health insurance is falling short and acting as if statutory health insurance was an ideal system,” said the head of the largest statutory health insurance company in the country with more than 12 million insured people.
With citizens' insurance, all citizens would basically pay into a common, income-dependent financed insurance system. Existing private contracts also have grandfathering rights; a conversion would take years or decades, he explained.
The economists Jens Boysen-Hogrefe and Ulrich Schmidt from the Kiel Institute sent their proposal for a “middle ground” in a letter to the federal government and the industry entitled “How a solidarity contribution in private health insurance reduces financing problems and injustices in health care”.
The core idea: Anyone who has a correspondingly high income and switches to private health insurance should pay an additional solidarity contribution for the statutory health insurance. Around 90 percent of the population in Germany is legally insured and around ten percent is privately insured. The second group includes civil servants, the self-employed and people with comparatively high earnings.
In statutory health insurance (GKV), the contribution is largely based on income. Anyone who earns a lot also finances the costs of other insured people. In private health insurance, on the other hand, the premium is not based on income, but rather on the expected benefits.
This is where the Kiel-based Boysen-Hogrefe and Schmidt come in: With a high earner, the GKV also loses a contributor to the solidarity compensation when he switches to PKV.
Financially speaking, switching to private health insurance is most likely to be worthwhile for those without children; families often get cheaper insurance with statutory health insurance: under certain conditions, family members can be insured without paying contributions under statutory health insurance. In private health insurance, on the other hand, everyone has to take out their own insurance contract.
For their proposal, the economists from the Kiel Institute calculated solidarity contributions for PKV insured people of different ages: From the insurance contribution of a high earner in the GKV, they deduct the average health expenditure of a comparable insured person in the PKV. In simple terms, the difference corresponds to the solidarity contribution. Age, gender and marital status are taken into account in the calculation.
For a single man between 25 and 45 years old, the calculation amounts to 622.60 euros in solidarity tax per month, for a woman of the same age 542.50 euros. With one child, the sum for this man drops to 444.50 euros, with two children to 266.40 euros.
With increasing age, the solidarity contribution continues to decrease. According to the economists' proposal, a single man between the ages of 66 and 75 still has to pay 131.20 euros.
From the age of 76, the values even become negative. The authors therefore propose the solidarity contribution primarily for privately insured people with their own income of working age.
However, the economists have not determined how much money the solidarity contribution from private health insurance would bring in total. However, they refer to a study by the Bertelsmann Foundation and the consulting firm Iges Institute from 2020.
Accordingly, the GKV would collect around nine billion euros more in contributions annually if all citizens were legally insured. The contribution rate could then fall by 0.2 to 0.6 percentage points. According to the study at the time, privately insured people had, on average, 56 percent higher incomes and a more favorable risk profile. According to industry estimates, in 2025 there were around 8.8 million privately insured people in the country.
Kiel's Boysen-Hogrefe and Schmidt, on the other hand, want to strengthen the financial basis of the GKV without giving up the dual system. In their model, the basic choice between PKV and GKV is retained. In addition to their premium, certain privately insured people would pay a solidarity contribution, which would equalize their health insurance contribution in total to that of a GKV insured person. The reference to the Bertelsmann Iges study gives hope for additional annual income in the billions of euros with this model.
