A proposal by the German Employers’ Associations (BDA) to reintroduce a fee for doctor visits has triggered sharp opposition from unions, patient advocacy groups, and physicians. The idea, presented by BDA chief executive Steffen Kampeter, comes in the wake of mounting financial difficulties for Germany’s statutory health insurance system.
Kampeter told the news outlet Politico on Wednesday that Germany needed stronger mechanisms to control the frequency of medical consultations. “Patient steering must improve,” he said. “We propose a contact fee to be charged for every doctor visit. Unnecessary appointments are making the system more expensive.” According to him, the measure would not primarily serve to generate revenue but to discourage “doctor-hopping,” a practice in which patients consult multiple physicians of the same specialty for the same issue.
While Kampeter did not specify an exact amount for the proposed fee, he stressed it should be high enough to influence behavior. He also criticized the overall trajectory of Germany’s social spending, arguing that the welfare state had grown faster than the country’s economic capacity. “This cannot work in the long run,” he warned, describing the welfare system as “quasi insolvent.”
The proposal immediately drew sharp criticism from trade unions. Anja Piel, a board member of the German Trade Union Confederation (DGB), dismissed the idea as a “populist summer stunt.” She argued that such fees create inequality: “Those with money won’t care, while those without may avoid necessary treatment.” Piel also pointed out that a similar system, the “Praxisgebühr,” was tried between 2004 and 2012 but proved ineffective.
Patients were charged ten euros per quarter for doctor visits, but the measure created more administrative burden than benefits. She called instead for a sustainable increase in federal subsidies to statutory health insurance and the establishment of a universal insurance system covering all citizens.
Patient advocates voiced similar concerns. Eugen Brysch of the German Foundation for Patient Protection called the suggestion “the same old story,” noting that the previous fee failed to reduce unnecessary visits. Instead, he argued, it delayed important consultations, sometimes with severe consequences for patients’ health. “The administrative effort for practices was enormous, and some people sought medical help far too late because of the fee,” Brysch said.
Germany’s family doctors also rejected the proposal in strong terms. Nicola Buhlinger-Göpfarth, chair of the German Association of General Practitioners, told the Rheinische Post that the plan was “not only antisocial but also completely ill-conceived.” She warned that the fee would not only deter avoidable visits but also essential ones, such as cancer treatments, vaccinations, and other urgent consultations. Chronically ill patients, including those requiring dialysis, could end up paying dozens of times a year, she added. “That would place an unbearable financial strain especially on the most vulnerable,” she said.
Buhlinger-Göpfarth also emphasized the potential long-term costs: when patients skip preventive or timely care due to financial barriers, illnesses may worsen, leading to more expensive treatments later. While she acknowledged that Germany sees a particularly high number of doctor-patient contacts compared to other countries, she argued that the solution lies not in blanket fees but in a better-organized primary care system. “The answer is not general contact charges, but better patient guidance. We need a system where the family doctor is the first point of contact, referring patients to specialists only when necessary,” she explained.
The debate over Kampeter’s proposal echoes the failed experience of the 2004–2012 Praxisgebühr. Despite its introduction as a cost-containment measure, studies found it did little to change patient behavior while adding bureaucratic complexity. Its eventual abolition in 2012 was broadly welcomed by both patients and medical professionals.
For now, the proposal appears to have little political traction, as opposition from unions, patient advocates, and doctors suggests significant resistance. Nonetheless, the controversy underscores the growing financial strain on Germany’s healthcare system and the contentious debate over how to secure its long-term sustainability.
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