Expert Commission Proposes 66-Point Plan to Reform German Healthcare System

A ten-member expert commission presented a 66-point plan on Monday to reform Germany's statutory health insurance system, warning that without intervention the funding shortfall between state insurers' income and expenses could reach 40.4 (billion euros) — projected GKV deficit by 2030 by 2030. Federal Health Minister Nina Warken of the CDU received the commission's 480-page report at a press conference in Berlin. The proposals carry a total potential financial volume of up to €42 billion for next year alone, exceeding the €15 billion deficit already projected for 2027. The commission, chaired by health economist Wolfgang Greiner of the University of Bielefeld, drew on roughly 1,700 proposals submitted by associations and organizations across the healthcare sector before distilling them into 66 recommendations.

„I'm grateful that the commission has presented us with a well-filled toolbox, from which we will now take the best tools.” — Nina Warken via Deutsche Welle

Warken added that there would be no one-sided reforms burdening the insured and that the cornerstones of a solidarity-based healthcare system would not be shaken. According to a web search result, Warken said the commission's proposals would form the basis for legislation to be approved by cabinet in July.

Doctors, hospitals face the largest savings demand

The commission identified service providers — doctors' practices, hospitals, and pharmaceutical manufacturers — as carrying the greatest savings potential, at 19 (billion euros) — savings target for healthcare providers and manufacturers. The central principle underpinning that target is that remuneration for providers should not rise faster than the insurers' revenues. A further €12 billion could be generated if the federal government fully assumed the insurance costs of recipients of Bürgergeld, which the commission classifies as a non-insurance-related benefit that should not fall on the statutory funds. Patients themselves are expected to contribute up to €4.1 billion, primarily through an inflation-adjusted increase in co-payments for medicines — the commission recommends raising the ceiling to up to €15, noting that co-payments have remained largely unchanged since 2004. An additional €4.8 billion on the revenue side would come from abolishing contribution-free co-insurance for non-working spouses, a measure that would affect around 1.6 million people, with possible exemptions for parents of young children.

Healthcare providers and manufacturers: 19, Federal government (Bürgergeld and non-insurance benefits): 12, Patient co-payments and revenue measures: 4.1, Abolishing spousal co-insurance: 4.8

Sugar taxes and tobacco levies round out the package

Beyond structural changes to contributions and provider payments, the commission recommended introducing a tiered tax on sugar-sweetened soft drinks and raising existing taxes on tobacco and alcohol, with the additional revenue directed to the GKV. The commission also stressed the importance of strengthening scientifically based care and expanding prevention measures. Wolfgang Greiner framed the package as a tool to prevent the solidarity principle of the statutory system from eroding under the weight of rising costs.

„The proposals open up broad scope for political action for further design. In particular, they help ensure that health insurance funds do not spend more than they take in and thus rising contributions and therefore additional burdens for insured persons and employers are prevented.” — Wolfgang Greiner via Berliner Zeitung

Without reforms, the commission calculated that an average earner would face additional annual contribution costs of around €260 in 2027, rising to around €680 by 2030, with a maximum additional burden of €1,440 per year in 2030.

System already among the world's costliest, efficiency questioned

Germany's healthcare system is one of the most expensive in the world and the most expensive within the European Union, according to the Berliner Zeitung, with total daily expenditure across all payers running at close to €1.4 billion. The GKV alone accounts for the largest share, spending around €1 billion per day. Preliminary figures from the Federal Ministry of Health show that in 2025 the GKV recorded expenditures of €352.4 billion against revenues of €355.9 billion — a technical surplus — but expenditures grew at 7.8 percent while contribution income rose only 5.3 percent, widening the structural gap. Hospital treatment accounted for roughly one-third of total GKV spending, which the ministry identified as the decisive driver of cost growth, followed by medicines at 17 percent and doctor visits at 16 percent. The chairman of the National Association of Statutory Health Insurance Physicians, Andreas Gassen, said before the presentation that he considered the planned savings target unrealistic, arguing that non-insurance benefits should first be removed from the GKV's coverage catalog.

Germany operates a dual health insurance system in which statutory insurers, the GKV, cover approximately 90 percent of the population and are legally prohibited from refusing coverage to any applicant. Around 10 percent of the population hold private insurance. Contributions are split equally between employees and employers and are calculated as a percentage of gross income, with a general rate of 14.6 percent supplemented by an average additional contribution that rose to 2.9 percent at the start of 2026. The system has faced recurring criticism that financial incentives push hospitals and doctors toward expensive or unnecessary treatments, driving up costs without corresponding health gains.

Key milestones in the GKV reform process: — ; — ; —