Lower health insurance contributions – that would be possible and fair

The head of one of the largest German health insurance companies chose drastic words: those with statutory health insurance are threatened with a “contribution shock”. Contributions will rise to an average of 17.1 percent at the beginning of the year.

A new analysis by the Federal Ministry of Health shows: Health care became eight percent more expensive in the first three quarters of this year compared to the previous year. Cost drivers include hospital treatment, expenses for nursing staff, outpatient operations, rehabilitation services, therapeutic products and home nursing care. Administrative costs, on the other hand, have hardly increased, and people usually tend to blame them. With this logic, an increase in contributions seems inevitable. But there is an alternative: make them fairer.

The “additional contribution” is more expensive – i.e. the amount that each health insurance company charges its insured persons individually in addition to the “general contribution rate” of 14.6 percent. Depending on how well a provider is doing financially, this can range from zero to more than three percent. When the letter from the health insurance company arrives in the mailboxes of the 55 million insured people in the next few days, everyone will be free to switch to a cheaper insurance policy. But the basic problem remains: all health insurance companies are cash-strapped.

What does the increase mean in euros? An average earner with a gross monthly salary of 3,540 euros then pays around 14 euros more in contributions, and the employer pays another 14 euros. Freelancers pay everything themselves, i.e. 28 euros.

Some people might think: Sounds manageable. But where will this lead in the coming years? Ultimately, life becomes more expensive overall. People are getting older and sicker. There is a risk of further increases – for many health insurance companies, probably as early as 2025, like this year. 34 providers increased their contributions by the end of November – some even twice because there wasn’t enough money again.

Politicians must now find ways to reduce contributions by reducing spending. There are well-known suggestions: a “primary doctor system” in which the family doctor controls the flow of patients as the main contact. More outpatient medical services. The overdue emergency reform. A new system for patent-protected medicines, which until now have often come onto the market at fantasy prices. A deductible for the costs of medical treatments.

But how quickly would these measures take effect? A reduction in contributions would already be possible. And by a good three percent. Then our average earner would pay almost 59 euros less as an employee, and around 118 euros as a freelancer.

What would it take for that? First and foremost, health insurance companies should not co-finance citizens’ benefit recipients. This is a task for society as a whole in which privately insured people and indeed all taxpayers should also take part. The idea of ​​statutory health insurance, on the other hand, is based on solidarity: everyone pays as much as they can based on their earnings, and everyone receives the same medical benefits in the event of illness.

Citizen benefit recipients pay nothing. Paying for your health is a so-called “non-insurance benefit”, which must also be paid by health insurance companies for pregnant women or parents of sick children, for example. With one important difference: the latter are completely refinanced by the federal government through a federal subsidy, but the solidarity community of the insured remains largely responsible for the benefits for citizens’ benefit recipients. If there were no payments for citizens’ benefit recipients, the health insurance companies would spend ten billion euros less next year, instead of 320 billion, only 310 billion, according to an estimate by the National Association of Statutory Health Insurance Funds. That would be around 3.1 percent.

A further 0.2 percent could – theoretically – be saved if all federal states fulfilled their obligation to pay for hospital maintenance and necessary purchases. They have been avoiding this task, which they are legally obliged to do, for years, which is why the hospitals divert money from the “flat rates” per case. However, these are actually only intended for treatment costs for patients including staff – but not for the new heating system or the computer tomograph.

Health Minister Karl Lauterbach has even cemented this misappropriation of health insurance funds through his hospital reform. It is to be financed, among other things, with 25 billion euros from the “health fund”, the pot into which the contributions of all legally insured people end up before they are distributed to the individual health insurance funds. That’s 2.5 billion euros annually for the next ten years, which will have to be saved in medical treatment. The legal scholar Dagmar Felix from the University of Hamburg rated this type of financing as unconstitutional in a report for the National Association of Statutory Health Insurance Funds. The association is now examining whether it could go to court.

In any case, every individual insured person could sue – but only after the 2.5 billion euros have been diverted from the health fund for the first time. So at the beginning of 2026. It is difficult to imagine that Lauterbach did not realize when the reform was passed that he was legally treading on slippery ice. He’s probably playing for time. It will take years until a judgment is made in this matter, during which the money will flow into hospital reform. And the health insurance companies have no choice but to cut further benefits – or further increase the additional contributions.

Of course, the expenses for citizens’ benefit recipients and hospitals do not disappear because they are deducted from health insurance contributions. But if they were financed through taxes instead, it would be fairer: everyone would pay. Those who earn more and often have private insurance would pay more. As befits a community of solidarity.