The statutory health insurance estimators predict stable additional contributions of an average of 2.9 percent with a general contribution rate of 14.6 percent for the coming year.
According to Boris Augurzky, the contribution rate stabilization law shifts burdens and leads to a loss of revenue for hospitals.
Augurzky sees potential in reducing bureaucracy as well as through more outpatient treatment and the use of artificial intelligence.
The sugar tax is intended to motivate manufacturers to reduce sugar content; However, Augurzky criticizes that it serves more to close budget gaps.
Dusseldorf. The statutory health insurance (GKV) estimators have forecast stable contribution rates for the coming year. Accordingly, the additional contributions should remain at an average of 2.9 percent. In addition, there is the general contribution rate of 14.6 percent.
But experts only see this as a short-term relief, including health economist Boris Augurzky from the RWI-Leibniz Institute for Economic Research in Essen. The burden would simply be postponed with the Ministry of Health's Contribution Stabilization Act. As a result, hospitals are now faced with a financing problem.
He sees useful instruments in targeted reductions in bureaucracy, but also in prevention. He criticizes the handling of the sugar tax, which has been passed by the cabinet but is still met with reservations in the CDU/CSU parliamentary group. The tax on sweetened drinks should be an incentive for manufacturers to reduce sugar content, says Augurzky. Ideally, it would bring in hardly any taxes. He criticizes the fact that this is intended to plug budget holes.
Mr. Augurzky, according to the group of estimators' forecast, has the financing gap in the health insurance companies been closed?
You can certainly breathe a sigh of relief for next year. That's what it was all about - stabilizing the contributions for 2027. The contribution rate stabilization law appears to be working. But that doesn't mean that there's nothing left to do in the medium term. The law is designed to make across-the-board cuts, so it includes measures where everyone has to give something away in the short term. These are not particularly smart measures to stabilize the system in the long term.
The Federal Ministry of Health expected a financing gap in statutory health insurance companies (GKV) of 18.8 billion euros by 2027.
The Federal Government's Contribution Rate Stabilization Act should prevent contributions from having to rise significantly in 2027 in order to close the financing gap. The average additional contribution rate has more than doubled from 1.3 percent to 2.9 percent since 2022. The savings package includes, among other things, an increase in the contribution assessment limit by 300 euros per month and a higher surcharge for those without children.
With the savings package, health insurance companies no longer have to co-finance certain hospital costs, such as collective wage increases. The flat rate for care-relieving measures should also be reduced. According to the RWI hospital rating report for 2026, the average return on sales for hospitals could fall from 2.2 percent in 2026 to around minus two percent in 2027.
An expert commission set up by the Ministry of Health is expected to propose a series of structural reforms by the end of the year that are intended to help stabilize the health system in the long term. In their first report at the end of March, the experts had already presented 66 short-term measures.
In your opinion, what are the current construction sites?
A temporary restructuring has now been achieved with the health insurance companies. But it comes at the expense of service providers, including hospitals. For them it means a significant loss of revenue next year. These are side effects of the law that cannot be tolerated permanently. You pass the hot potato, so to speak, from the health insurance companies to the service providers. So that it is not just pushed back and forth, operating costs must fall everywhere.
How could that work?
An important lever is reducing bureaucracy. Hospitals have to meet a lot of requirements, for example how and which staff must be deployed and when. From 2019 to 2024, the number of staff deployed per hospital case increased by around 20 percent. In nursing it is even 30 percent. This is also due to the fact that a lot of regulation and therefore costs have been added, even though our economic strength remains at the level of 2019. We should admit that as a country we can only afford the level of 2019.
Boris Augurzky is a health economist at the RWI-Leibniz Institute for Economic Research in Essen. He also teaches at the University of Duisburg-Essen.
Augurzky was a member of the “Government Commission for Modern and Needs-Based Hospital Care” of the Federal Ministry of Health under the former Health Minister Karl Lauterbach (SPD).
Do you only see this responsibility as being in the hands of politicians – or do hospitals have to get involved too?
With both. Firstly, companies themselves must have the courage to bring about change. This is particularly difficult for municipal health insurance companies, which also have to coordinate with local politics. Many hospitals are there too. Secondly, I expect federal policy to enable health insurance companies and other healthcare providers to implement efficiency measures. The healthcare system is highly regulated. Take hygiene regulations, fire protection regulations or even non-technical requirements such as the Supply Chain Due Diligence Act. We should not aim for all of these targets at a very expensive 100 percent level. Reducing bureaucracy is an important starting point.
Are there any other strands that could be started?
The second strand is the reduction of the incredibly high volumes of services that we have in the German healthcare system. In international comparison, we go to the doctor very often and also go to the hospital more often than average. In many cases this is for reimbursement reasons, and patients could also be helped in a cheaper way.
What does this actually mean in practice?
On the one hand, many inpatient services could also be provided on an outpatient basis. Some topics could also be more strongly supported by AI. The next big lever is prevention, which, however, cannot be easily integrated into existing compensation systems. Greater patient participation would also help. This is often standard abroad. In this country, however, this is viewed very critically because they do not want to burden low-income patients. But that's not actually a counter-argument, because you can always balance your own contribution socially. However, politicians are afraid of a large number of votes from the middle class.
The sugar tax also falls into the prevention category. However, there has been repeated political discussion about this in recent weeks. What do you think about the tax?
If you introduce it purely for health reasons, it makes sense. But one has the feeling that the finance minister wants to close budget gaps. If I raise a sugar tax and then exclude small companies, I will not achieve the health goal across the board. The goal must be for all companies to reduce the sugar content of the food they sell so that the tax does not arise in the first place. It's like pricing CO₂ emissions. It is done so that CO₂ emissions fall, and not so that the state collects even more taxes.
How do you view the debate about whether privately insured people should be involved in the GKV?
On a greenfield basis, no country would introduce our system with parallel statutory and private health insurance. In my opinion, a salary-independent health allowance for all citizens would be the ideal option. Anyone who cannot afford this with their income receives tax-financed social compensation - like in Switzerland. This would also be fairer than the wage-dependent social compensation currently organized through health insurance. However, we have to start from the existing system. Abolishing private health insurance would not lead to a socially cushioned health care allowance for everyone, but would only further expand the wage-based redistribution in statutory health insurance. In addition, the expiry of PKV would only occur very slowly, namely until the last person insured with PKV dies. The effects for the GKV would then only be slightly noticeable.
How realistic do you think it is that structural reforms will actually be implemented in the coming year?
My experience says that action is never taken as much as I would like as a health economist. However, the pressure to act is now enormous. The minister has to act because social security contributions are going through the roof. Lowering the contribution rate for pension and nursing care insurance is unrealistic or politically inappropriate. So you have to save with the GKV - and that's where you have the most leeway through clever reorganization in the system.
Mr. Augurzky, thank you very much for the interview.
