66 ways to fix Germany's costly health care system

A special commission has presented a raft of proposals aimed at curbing Germany's spiraling health care costs.

But whether the government can impose them is another matter.

A commission of experts presented a 66-point plan on Monday that is meant to lower the ever-growing health insurance contributions that Germans have to pay into the system.

Germany's health care system is one of the most expensive in the world, with state health insurers alone spending around €1 billion ($1.15 billion) per day on health care — a number that is expected to rise even more in the next few years.

Meanwhile, Germans' insurance contributions to those state health insurers rose by an average of around 3% this year, on top of a 2.5% rise in 2025.

But despite the rising contributions, state insurers' expenses are increasing even more rapidly.

At the press conference, the commission held up a graphic — from the state insurers' association, the GKV — which showed that at the current rate, the shortfall between state insurers' income and expenses would increase from €15.3 billion in 2027 to €40.4 billion in 2030.

Health care in Germany: Inside a system at breaking point
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Closing the health care expenses gap
The 66 recommendations presented on Monday were designed not only to close that gap, but to make even more savings.

The 10-member commission, which included experts from the fields of economics, medicine and social law, was specifically charged with coming up with too many recommendations as the government is unlikely to be able to implement all of them, if only for political reasons.

"I'm grateful that the commission has presented us with a well-filled toolbox, from which we will now take the best tools," Federal Health Minister Nina Warken of the conservative Christian Democratic Union (CDU) said at the press conference.

"It's important for me to emphasize that there will be no one-sided reforms that will burden the insured.

We will not shake the cornerstones of a health care system based on solidarity."
The commission's 480-page report included proposals such as:
Eugen Brysch, chair of the German Foundation for Patient Protection (DSP), an organization that protects patients' rights, said the 66 proposals could all have been found lying in the filing cabinets of various health care organizations, but that it was up to the government to agree on a clear plan.

"It's time for the government to show its colors," Brysch told DW in a statement.

"The financial gap needs to be addressed.

Sustainable health insurance can't be done by a financial commission, only by the government, and for that they need a unified concept." Brysch predicted, for example, that the proposal to have the government pay the health insurance for the unemployed would lead to a political row in the coalition government.

Poorly treated?

Racism in German medicine
The ins and outs of the German health care system
Germany has a dual health care system funded by employees' and employers' contributions to health insurers.

Health insurance is mandatory for the entire population, and state insurers, which cover around 90% of the population, are not allowed to refuse anyone insurance.

Around 10% of the population opt for private insurance, which often offers more cover.

But in the past, critics have raised concerns that hospitals and doctors are incentivized to recommend expensive and unnecessary treatment, burdening the health insurance companies and driving up contributions.

Health Minister Warken promised that the commission's proposals would be examined quickly and that her department would draw up a draft bill to present to the Cabinet by the summer.