Dusseldorf. According to the GKV estimators, the statutory health insurance contributions (GKV) are likely to remain stable in the coming year. “We have achieved our most important goal,” said Health Minister Carsten Linnemann (CDU) on Wednesday evening when announcing the forecast. For contributors, this is a reason to breathe a sigh of relief, but experts warn that the effects could only be short-term. They also propose more far-reaching reforms to stabilize contributions in the long term.
The estimated result results in an average additional contribution rate of 2.9 percent for 2027. The GKV Estimator Group is a committee of experts made up of members of the Federal Office for Social Security, the Ministry of Health and the National Association of Statutory Health Insurance Funds. He advised on Tuesday and Wednesday and gives a forecast for the development of contributions every year.
For the current year, expenses are expected to increase by almost seven percent. Next year, the increase is expected to fall to less than three percent, according to the ministry. Expenditure on statutory health insurance will therefore amount to 370 billion euros for 2026. Next year they are expected to rise to 378 billion euros.
The individual funds now determine their contributions for the coming year individually. The range is currently between 2.18 and 4.39 percent among 93 health insurance companies. “With yesterday’s result from the estimators, the chances of stable contributions in 2027 have at least not diminished,” says the DAK. But it is still too early to make a determination.
Contributions remain stable – for now
Contributions have increased significantly in recent years. The average additional contribution rate has more than doubled from 1.3 percent to 2.9 percent since 2022 - and could continue to rise in the medium term. The Ministry of Health's reform package has so far focused primarily on spending cuts for the coming year and curbs until 2030.
However, the budgetary situation of the health insurance companies remains tense. Verena Bentele, president of the social association, calls the estimate just “a short breather”. Many health insurance associations reacted similarly.
A study by Deloitte, which was exclusively available to the Handelsblatt, shows drastic cost increases for the coming years: According to this, without more far-reaching reforms, the deficit threatens to grow from the expected 19 billion euros in the coming year to around 117 billion euros in 2035 - that would cost average contributors an additional 471 euros per year. The cost increase would be even higher if modern technologies were to be promoted.
What reforms need to follow now?
Boris Augurzky, health economist at the Leibniz Institute for Economic Research in Essen, also takes a critical view of the Ministry of Health's previous measures and the contribution stabilization law. "The whole law is intended to make cuts; these are not particularly smart measures. But they were needed to stabilize the system to some extent in the short term."
Above all, he sees a challenge: the austerity measures are a kind of “hot potato” that was “thrown over” by the health insurance companies to the clinics, among others, with the previous reform. “I hope that in the long term we don’t just push the hot potato back and forth.”
Linnemann is aware of the short-term nature of his planned cuts and announced: “We have to solve the structural problems of statutory health insurance and put its financing on a solid basis in the long term.”
By the end of the year, a finance commission set up by the Federal Ministry of Health is expected to present proposals for medium and long-term structural reforms in the healthcare system. In their first report at the end of March, the experts had already presented 66 short-term measures. This primarily includes efficiency gains and a quantitative reduction in perceived services, for example through health prevention.
“Our healthcare system must be turned topsy-turvy to ensure modern medicine for everyone with statutory health insurance,” says Gregor-Konstantin Elbel, author of the Deloitte study. His study shows how reforms not only prevent an increase in contributions, but could even lead to relief for contributors. Bentele also calls for this: “Reduce contributions instead of stabilizing them – that’s what people really need.”
But it is already clear how difficult it is to implement structural reforms. For example, the sugar tax passed by the cabinet on Wednesday was discussed for a long time. In the meantime, zero drinks should also be included.
That would have increased tax revenue for the Ministry of Finance, but would have deprived the reform of its health policy meaning - namely to give companies an incentive to reduce the sugar content in drinks. Augurzky believes the measure makes sense overall. In order for it to fulfill its purpose, it must be implemented without exceptions, he says.
The planned relief for the pharmaceutical industry in terms of discounts is also met with criticism. The industry reacted with alarm after the Ministry of Health wanted to ask companies to pay. It warned that this would endanger its competitiveness and withdrew some investments from Germany.
The government then backed down again, which in turn triggered criticism from the health insurance companies. “Politicians have made financial concessions to some service areas, which now have to be counter-financed by other measures,” criticized Ulrike Elsner, chairwoman of the Association of Replacement Funds, which represents the largest health insurance funds in Germany.
This is also causing dissatisfaction at the DAK: “If the pharmaceutical sector is now to be relieved of 1.3 billion euros in the short term, then this must not be at the expense of the contributors.” It is said that the federal government should compensate for the losses with tax revenue.
The president of the social association, Bentele, calls for “the merger of private and statutory health insurance”. The SPD had previously called for the project. However, how such a merger could be implemented in practice is controversial.
Health economist Augurzky hopes that the austerity pressure will be sufficient to push forward reforms: “Experience shows that structural action is never taken as much as I would like,” he says. "But the pressure to save money is currently immense. This opens up opportunities for structural reforms."
