Berlin. Federal Health Minister Carsten Linnemann (CDU) had already proposed reducing the number of statutory health insurance companies in April 2026, when he was still CDU general secretary. In August he brought the maximum number of 20 into the debate.
In an interview with Handelsblatt, he explained that he wanted to wait for the report from the Finance Commission, which would like to present its proposals for reform at the end of December. But Linnemann already indicated: “For me it’s not just about size, but about what a health insurance company has to do, for example in the digital age.” From his point of view, data processing and artificial intelligence (AI) are also crucial. “That’s why the structures of the health insurance companies also have to change,” said the minister.
At the beginning of 2026, according to the National Association of Statutory Health Insurance Funds, there were almost 93 statutory health insurance companies in Germany. Linnemann hopes that fewer cash registers will result in less administrative work and lower costs. But does the size of a health insurance company actually make a measurable difference when it comes to digitalization and AI? And would mergers make the healthcare system cheaper?
Figures from the IT service provider Bitmarck show how many health insurance companies could be affected. According to the company, of the 68 company health insurance companies that Bitmarck supplies with IT services, 55 have a maximum of 250,000 insured people. Linnemann had previously brought such a minimum size into play. It is not binding.
New legal requirements would be necessary for a legally required minimum size or a general reduction in the number of cash registers. There is currently no specific draft law on this. The minister wants to wait for the second report from the Health Finance Commission. His considerations could still have consequences for smaller funds, because the commission's recommendations are not binding. It remains to be seen whether and how Linnemann will implement these reforms.
“An advantage is plausible, but especially in administration,” says Annika Herr, health economist at Leibniz University Hannover. Developing, launching and maintaining digital applications is expensive. Large health insurance companies can spread these expenses across more insured people and have larger data sets for AI models.
But that doesn't automatically make them more powerful. “The number of insured people alone is not a reliable indicator of digital performance,” says Herr. Better medical care through larger health insurance companies has not been scientifically proven.
Digital performance can be measured, for example, by how many administrative processes are automated, how reliably digital services work and how quickly applications are processed. However, there is no generally accepted overall value that makes the funds comparable based on such criteria.
Smaller insurers can share costs through common IT service providers. At Bitmarck, cash registers use an AI marketplace to jointly develop and test applications from which around 80 customers can then benefit. These customers include company and guild health insurance companies as well as substitute health insurance companies such as DAK-Gesundheit. Bitmarck provides, among other things, software for administration and digital offers for insured persons.
AOK Bayern and AOK PLUS also use several hundred applications together via kubus IT, including AI-supported systems and the oscare management software. Both remain legally independent and can design regional offerings differently.
“The magic word is cooperation behind the scenes and bundling the infrastructure with central service providers,” says Anne-Kathrin Klemm from the BKK umbrella organization. However, legal limits on administrative costs would make investments in new technology more difficult. It also calls for simpler rules for training its own AI models so that data from different health insurance companies can be used together and in compliance with data protection regulations.
Herr sees advantages in voluntary mergers when technology and strategies fit together. She is skeptical about politically forced mergers: “Because the economies of scale of digitalization have not been clearly proven empirically, it is difficult to reliably predict scientifically whether forced mergers will have any effect here.”
Linnemann's initiative has met with criticism from the BKK umbrella organization. “I don’t believe in that,” says Klemm. Supervisory authorities are already checking IT security and the implementation of legal requirements. In addition, the cash registers would have to assert themselves in the competition.
The head of the GKV association, Oliver Blatt, also rejects a political target number. “I am firmly convinced that a forced reduction to a certain number of health insurance companies does nothing to make the health system more efficient.”
The head of the association explains that the number of cash registers has already fallen significantly. Around 30 years ago there were more than 1,000, at the beginning of next year there will probably be fewer than 90. Blatt supports economically sensible mergers. "But politically speaking, why should there be exactly 20 cash registers - and not 50 or ten? The competition should regulate that."
