The announcement by Federal Minister of Health Karl Lauterbach (SPD) that he would also increase contributions to close the financial gap in statutory health insurance (SHI) met with a mixed response from health insurance companies.

"In order to close the huge financing gap, we need a clean regulatory solution and no annual financing poker," said a spokesman for the National Association of Statutory Health Insurance Funds in Berlin.

Christian Geinitz

Business correspondent in Berlin

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The contribution increases promised by Lauterbach could be avoided if the federal government lowered VAT on pharmaceuticals and also fully counter-financed the health care of unemployment benefit II recipients.

That would bring 15 billion euros into the till, according to the spokesman: "The solution is on the table, the financial and health policy is required."

The chairwoman of the AOK Federal Association, Carola Reimann, sees Lauterbach's proposals as good starting points.

"The financial problem in the GKV is pressing, the sooner a solution is found, the better.

A mix of measures is absolutely necessary for this," she said on Thursday in Berlin.

Everything must be done to plug the forecast financial gap in 2023: "Increasing the contributions, on the other hand, can only be the last resort."

Is it about the additional contributions?

Lauterbach had previously spoken of various "adjusting screws" that needed to be turned.

You have to raise efficiency reserves in the health system, use reserves in the health insurance companies, "grant additional federal grants and increase the contributions," said Lauterbach of the "Neue Osnabrücker Zeitung".

He had made a similar statement before and also assured that there would be no cuts in benefits on the expenditure side.

The minister left it open how much the contributions would have to increase: "It would be unprofessional if I told you about the ongoing talks here." It is also unclear whether Lauterbach has the general contribution rates in mind that apply to everyone, or the additional contributions which may vary.

His house could not provide any information on Thursday.

Higher federal grants

Reimann, who used to be the SPD Minister of Health in Lower Saxony, called for an agreement “as soon as possible” on greater federal participation in the costs of statutory health insurance.

That can't wait until autumn.

Lauterbach had said that he did not want to commit himself to an appointment before the summer break to present a "well-considered draft law".

Ulrike Elsner, head of the substitute health insurance association Vdek, praised the fact that Lauterbach wanted to get the financing law off the ground.

In 2023, around 17 billion euros were missing in the system, which had to be raised through a "bouquet of measures".

"Responsibility for this should be distributed fairly," says Elsner.

The efficiency reserves mentioned by the minister relate, for example, to the pricing of medicines.

It also applies, as requested by the central association, to reduce the value added tax from 19 to 7 percent.

The reduced rate applies to food in Germany and also to medicines in many EU countries.

Elsner also welcomed the fact that Lauterbach was apparently planning higher federal subsidies on a permanent basis.

The regular figure is 14.5 billion euros, but this year there will be an unscheduled 28.5 billion.

"On the other hand, we are critical of the fact that politicians are apparently planning to fall back on the health insurance reserves again," complained the head of the association.

The cash registers have had to pay many billions from their assets in the past two years.

"These are funds from the contributors that should actually be available for the supply." Elsner also said about the tariff increase: "Increasing contribution rates can only be the last resort."

As can be heard, insurers favor an increase in the general contribution rate, if at all.

This has remained unchanged at 14.6 percent in all health insurers since 2015.

The additional contribution varies and has been changed several times.

The average is 1.3 percent.

Most recently, there was talk that it would have to increase to at least 2.3 percent in 2023.

The federal subsidy is used to finance non-insurance benefits.

Like the central association, Elsner and Reimann point out that the allocations from the social budget for the contributions of unemployment benefit II recipients are far from sufficient.

Here, 10 billion euros are missing per year.

The coalition agreement states that this contribution gap will be closed, "that has high priority for us," said Elsner.

And Reimann also called this question "crucial".