Berlin, Germany – Federal Minister of Health Nina Warken (CDU) โคhas firmly ruledโ out reintroducing a flat-rate “practice fee” โfor doctorS visits, a policy
Recent proposals to increase financial contributions from patients within Germany’s healthcare system are meeting pushback from key โstakeholders, despite growing concerns over rising โขcosts. The debate centers around whether shifting more financial โคburden ontoโค insured individuals could alleviate pressure on statutory health insurance funds.
Hendrikโ Streeck,โข a virologist and health expert with โthe CDU, has advocated for models where patients contribute more directly to healthcare costs. He also serves as the Federal government Commissioner โfor Addictive and Drug Questions. His arguments draw parallels to systems in other European countries.
International Examples of Patient Contributions
In Switzerland, insured individuals actively choose their deductible level (“franchise”) โฃwithin the basic statutory insurance. A higher deductible translates to lower monthly premiums.โข Even after meeting the deductible, Swiss patients contribute ten percent of further costs, up to a legally defined maximum.
France requires patients to cover approximately 30 percent of outpatient doctor visit costs and around 20 percent of hospital expenses.sweden employs a tiered deductible system. Streeck reportedly observed a significant difference in doctor visit frequency across Europe,โ stating, “While people โฃin Denmark go to the doctor on average four times and five times a โคyear in France, Germans go to a practice on average ten โฃtimes a year.” he believes this higher frequency places a significant strain on the german system.
AOK Rejects Proposal, Cites Past Experience
However, the AOK Federal Association, a โขmajor statutory health insurer, firmly rejects Streeck’s proposal. CEO Carola Reimann acknowledges the escalating costs within the healthcare system,โฃ stating, “But we reject the therapyโข measures proposed by Hendrik Streeck and other therapy measures proposed, which amount toโข a stronger financial burden on the legally insured persons.”
Rather,Reimann โcalls for the federal government โขto fulfill its financial obligations regarding non-insurance benefits and for a greater focus on efficiency โฃand value within the healthcare system. She points to the previous implementation of a practice fee in Germany – a ten-euro โขquarterly charge for doctor visits from 2004โฃ to the end of 2012 – as a cautionary tale.
“The experience had shown that ‘this principle does not lead to savings thru cost -conscious behavior of the insured,'” Reimann explained. “Instead, additional paymentsโข and a higher deductible result in higher access barriers and can prevent people from visiting โคthe doctor and medical treatments. This is notably the weakest in society.” She urges the government to address “the really evident construction sites in the healthcare system and that there is no sham debate.”
Rising Healthcare Costs Fuel Debate
The debateโ unfolds against a backdrop of rapidlyโข increasing healthcare expenditures. In the โขfirst half ofโค 2025, statutory health insurance spending reached 174 billion euros, an almostโ eight percent increase year-over-year. Total spending forโ 2024 amounted to 326.9 billion euros, resulting in a deficit exceeding six billion euros. This financial pressure is driving the search for solutions,but the AOK and others remainโฃ skeptical that increased patient contributions are theโ answer.
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Berlin – A contentious proposal too reintroduce a patient โขcontact โฃfee for visits toโฃ generalโ practitioners inโค Germany is sparking debate among medical professionals, patient advocacy groups, and โemployers.The proposal, put forth by โemployer associations, aims to curb rising healthcareโ costs, but faces strong oppositionโ from those โwho argue it would โdisproportionately affect vulnerable populations andโ hinder accessโข to essential care.
Steffen Kampeter, general manager of the Federal Association โof German Employers’ Associations, advocated for a โfee per doctor visit in response toโข increasing contributionsโฃ to healthโ insurance funds.โ He suggested such a fee โคcould โฃencourage more โคresponsible patient โขbehavior and reduce unnecessaryโฃ appointments,oftenโ referred to โคas “doctorโฃ hopping.” This idea was โinitially presented โin the “Berlin Playbook” podcast of “Politico.”
However, the proposal was swiftlyโค met with resistance. Nicola โฃBuhlinger-Gรถpfarth, โchair of the general practitioner association, labeled the suggestion “anti-social and โขcompletely astounding.” She argued that chronically ill โpatients, who frequently enough โrequire frequent medical attention, would beโ unfairly burdened โคby the additionalโข cost. โ “in particular, that would completely overwhelm socially weak financially,” she warned.
Didโ You Know? Germany’s โhealthcare โฃsystem is based on statutory โฃhealth โฃinsurance, covering overโ 90% of the population. The system isโ funded through contributions from both employers and employees.
The German Foundation โคfor Patient Protection also voiced strong opposition, drawing parallels to a previous practiceโค fee that was โabolished โin 2012 โคafter failing toโฃ achieve its intended goals.eugen Brysch, a board โคmemberโ of โฃthe foundation, statedโข that the previous fee “increases from โthe sinking every year,” and ultimately failedโค to improve patient self-regulation. He also highlighted the administrative burden placed on medicalโข practices and the potentialโค for delayed care.
From 2004 to 2012, patients paid a fee of ten euros for their firstโค doctor visit each quarter.Brysch noted that thisโ system led to patients delaying seekingโค medical attention, potentially exacerbating health issues.
Proponents ofโ the fee argue that it could promoteโ more judicious use of healthcare resources. However, โฃcritics contend that a more effective solution lies in strengthening the primary care system. โ The concept of โa โprimary โขmedical doctorโ system, were family practices serve as theโ first point ofโ contact and โขcoordinate referrals to specialists, is โฃgaining traction as a potential option.
Sylvia Bรผhler, a Federal Executiveโข Member of the โBoard at the Verdi service โขunion, emphasized the need for a robust primary care system and sustainable solutions for healthcare access inโ ruralโ areas,โ rather than relying on financial disincentives. She argued that contact fees would exacerbate existing social inequalities โin healthcare access.
Pro Tip: Understanding โthe structure of the German healthcare system is crucialโ to grasping the complexitiesโ of this debate. The system is decentralized, with aโค significant role played by sickness funds and medical โassociations.
Sahra Wagenknecht, leader of the BSW party, condemned the โฃemployer proposal asโค “an affront,” suggesting โitโ could find favor with the current goverment due to its historical precedent.โ she warned against reviving the practice fee, fearing a return to policies โthat prioritize cost-cutting over patient โwell-being.
Theโฃ debate over the proposed contact feeโฃ underscores the ongoing challenges โfacing Germany’s healthcare system, including rising costs, an aging population, โคand regional disparities โขin access to care. What long-term solutions can Germany implement to ensure affordable and โequitable healthcare for all its citizens?
| Period | Fee Amount | Purpose | Outcome |
|---|---|---|---|
| 2004-2012 | โฌ10 | Discourage unnecessary doctor visits | Abolished due to administrative burden andโ lackโ of impact on patient behavior |
| 2025 (Proposed) | Amount Undetermined | controlโ healthcare costs and โreduce “doctorโ hopping” | Currently under debate; facing strong opposition |
Germany’sโค healthcare โฃsystem has undergone significant reforms in recent decades, driven by factors such as โdemographic shifts, technological advancements, and evolving societal expectations. The debate over the practice fee is part โคof a broader discussion about the sustainability โขand equity of the system. Key trends include a growing โฃemphasis on preventative care, the โintegration of digital health technologies, and efforts to address regional disparities in healthcare access. The ongoing challenge lies in balancing cost containment with the need to provide high-quality, accessible careโฃ for all citizens.
Disclaimer: โThis article provides general facts and shoudl not beโค considered medical or legal advice.
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