Economic advisor advocates for higher out-of-pocket costs for patients with statutory health insurance

German economic adviser Monika Schnitzer has called for higher out-of-pocket payments by statutory health insurance patients as costs in the healthcare system continue to rise. “Germany is the world champion when it comes to doctor and hospital visits,” Schnitzer told the Rheinische Post in comments published on Wednesday. “We need to strengthen prevention. But we will also have to increase co-payments.” She cited the practice fee as an example.

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“A clinic fee makes sense if it can be collected with minimal bureaucracy,” she said. “Instead of burdening doctors with this, health insurance funds could collect it.”

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A spokesperson for the National Association of Statutory Health Insurance Funds (GKV) criticised calls to reintroduce a clinic fee, saying they distract from the “fundamental problems in our healthcare system.” The spokesperson said GKV spending on higher fees, hospitals, medication and expanded services is expected to rise by around 23 billion euros next year, reaching approximately 370 billion euros.

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“No clinic fee will help against this spending dynamic,” the spokesperson said. What is needed, they added, are “fundamental structural reforms.” Schnitzer, who chairs the Council of Economic Experts, also warned that reforms are necessary. Otherwise, she said, statutory health insurance contributions could rise to 25 percent.

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“The healthcare system must become more efficient,” Schnitzer said. She suggested that services such as homeopathy and “other insurance-funded services without evidence” could be removed.

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She also called for a debate on medical treatments at very advanced ages. “At the same time, we must ask whether everything that is medically possible is also meaningful for the individual,” Schnitzer said. “We are living longer, and especially at very old ages, healthcare costs rise enormously. We must discuss whether it makes sense at such an advanced age to use all available therapies, which are often very burdensome.”

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A similar debate was recently called for by CDU health policy expert Hendrik Streeck. Writing in a guest article for the Rheinische Post in mid-November, he argued that not everything that is medically possible is also “ethically justifiable.” He called for investment in structures “that enable dignity – instead of interventions that generate revenue but no additional lifetime.”

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