The statutory health insurance funds in Germany recorded a surplus of €2.8 billion in the first half of 2025, but they remain under financial pressure. “This should not be misinterpreted, it is only a snapshot,” said Federal Health Minister Nina Warken (CDU) on Friday in Berlin. She warned that contribution rates are likely to come under pressure again next year, making reform urgently necessary.
The funds continue to face the challenge that their expenditures are rising much faster than their income. In the first half of the year, the 94 statutory health insurers spent 7.8% more than in the same period last year. According to the Health Ministry, hospital treatment costs remain a major driver of this spending growth. The first-half surplus provides little relief, as it is primarily intended to bring the funds’ financial reserves up to the legally required minimum level. At the end of the first half, the health insurers’ reserves stood at around €4.6 billion, equivalent to 0.16 months of expenditure, still below the statutory minimum of 0.2 months.
Minister Warken stressed the need for swift action. “The need for action is clear: we need short-term measures and long-term structural reforms,” she said in Berlin. She warned that failure to implement these reforms could lead to further increases in contributions. “We have no time to lose.” The coalition is agreed that the cycle of contributions rising at the start of each year must be broken.
Warken said that statutory health insurance faces a shortfall of €4 billion next year, with an additional €2 billion in long-term care. Expenditures in both areas remain “unabatedly high,” she emphasized. “The system cannot be financed without profound reforms.” The CDU politician announced that an expert commission will be convened later this month to develop reform proposals. “Final internal government coordination is currently underway,” she added. The reforms are intended to stabilize contributions by 2027.
At the end of June, the average additional contribution rate charged by the health funds stood at 2.92%, up from 2.5% in October 2024. Contribution income, excluding additional contributions, rose by 5.5% in the first half of 2025 compared with the same period last year. Rising income was outpaced by faster-growing expenditures.
Hospital treatment costs alone increased by 9.6%, or €4.8 billion, in the first half of the year. This was driven mainly by higher spending on nursing staff (+15.2%, €1.6 billion) and sharply rising costs for psychiatric treatments (+12.9%, €639 million). Expenditures on pharmaceuticals rose by 6.0%, or €1.6 billion. Outpatient medical treatment costs increased by 7.8%, or €2.0 billion, the fastest growth for the first half of a year in more than a decade, according to the Health Ministry. Administrative costs grew by 5.2%.
The AOK Federal Association called for swift relief for the funds and measures to limit short-term expenditures. “The Damocles sword of contribution increases still hangs over the statutory health insurance,” warned Carola Reimann, Chair of the AOK Federal Association. She added that Minister Warken seems to be waiting “for some money to appear somewhere in the federal budget.”
The Social Insurance Association VdK urged rapid structural reforms. “The insured must not pay the price,” said VdK President Verena Bentele. “Rising healthcare costs open the door to higher contributions, reduced benefits, or additional burdens in daily life.” The German Patient Protection Foundation called for more federal funding. “The federal government is in denial of reality, because without tax money, the lights go out in health and long-term care insurance,” criticized Eugen Brysch, head of the foundation.
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