KBV Board: We need an honest debate about what our healthcare system should achieve
28.07.2025 13:22
In light of the deficits in statutory health insurance, the KBV board is calling for a clear vision from politicians on how the system should be financed sustainably. This includes an inventory of what the statutory health insurance system is currently spending money on, Dr. Andreas Gassen, Chairman of the KBV board, told journalists on Wednesday.
According to Gassen, the problem is not one of revenue, but primarily one of expenditure. This is not due to the expenditure on outpatient care, but rather to a multitude of non-insurance-related services. He emphasized that it is incomprehensible that health insurance companies should pay for healthcare services for recipients of the citizen's allowance. That is the responsibility of the state.
To make the healthcare system more efficient, everyone must use resources responsibly, Gassen continued. He expects more honesty from politicians with citizens and that the impression is no longer created that everyone is entitled to everything, to any extent, at any time. "We need commitment. Not always just for doctors, but also for patients," demanded the KBV head. Patients who want to use the healthcare system without any commitment in the future should, for example, pay more than others. New tariffs offered by health insurance companies to their insured members are possible, for example.
There is some potential for savings within the statutory health insurance funds themselves, for example through efficiency improvements, said Gassen, citing a recent study by the auditing firm Deloitte on the financial situation of statutory health insurance. Their experts identified further savings potential through the expansion of digitalization, increased outpatient care, and lower medication costs.
To increase the revenue base, Gassen advocates for additional taxes on tobacco and alcohol, which should be earmarked for the health fund. "This will serve prevention and generate additional financial resources," he said.
Hofmeister: Bringing patients to the right level of care
Deputy CEO Dr. Stephan Hofmeister said it's unlikely that the currently much-discussed patient management approach will make outpatient care more cost-effective. Rising prices for medications and diagnostics alone speak against this.
In fact, however, management can help make care more efficient. "Namely, when we bring the patient to the right level of care at the right time," he explained, adding: "Primary care practices are particularly well-suited for managing the complex healthcare system and providing long-term support, especially for chronically ill patients." Hofmeister referred to the KBV's proposals for patient management, which the representative assembly adopted in May.
However, it is also clear that there must be exceptions to the control, be it for visits to an ophthalmologist, a psychotherapist, or for chronically ill patients who regularly receive specialist care. A patient undergoing dialysis doesn't just need to see their family doctor for a referral, Hofmeister said.
116117 in patient control
The board was convinced that the 116117 care platform had proven to be the right solution for acute cases. A survey revealed that at least 60 percent of respondents knew 116117, the KBV chairman said. Since the number was explicitly mentioned in the coalition agreement, the KBV is offering politicians the opportunity to expand it into a nationwide platform for appointment scheduling and care management.
However, government funding is essential for this, added KBV board member Dr. Sibylle Steiner. With a Practice Future Act, politicians should not only secure investments in the technical infrastructure of the 116117, but also support practices in digitizing. This is also how politicians handled the digitization of hospitals. "In the long run, practices cannot finance the high investments in modern practice IT and cybersecurity exclusively from their own resources," said Steiner.
In this context, she emphasized the central importance of outpatient care, with its approximately 100,000 medical and psychotherapeutic practices. These not only form the backbone of outpatient care, but also "handle 97 percent of treatment cases in the German healthcare system."
Steiner: Recourse risks jeopardize vaccination targets
Steiner also called for urgent support for practices regarding reimbursement. Recourse risks should not jeopardize vaccination targets, as is the case with the upcoming flu vaccination this fall. Doctors should also not be held liable if, for example, they have to order individual doses of vaccines instead of more cost-effective bundle packs due to supply bottlenecks.
The KBV has detailed these and other proposals in a concept for the reform of performance audits and submitted it to the Federal Ministry of Health. One of the KBV's concerns is to reduce the number of performance audits for medical and prescribed services. The effort this entails for physicians, associations of statutory health insurance physicians, and health insurance funds is disproportionate to the revenue the funds would ultimately receive.
Steiner: "We continue to demand a de minimis limit of 300 euros per doctor, health insurance company and quarter for all types of prescriptions." This could eliminate around 70 percent of cost-effectiveness audits in the pharmaceutical sector.
Around a quarter of practices without an ePA module
Steiner expressed at best moderate satisfaction with the progress of the implementation of the electronic patient record (ePA) so far. He stated that the system is not being used as it should be during the current voluntary use phase. The reason: Around a quarter of practices still lack the necessary software module.
While some PVS manufacturers planned to deliver the module in the third quarter, others have provided no feedback at all. "This is unacceptable. We will therefore continue to push for all practices to be able to integrate the ePA into their daily work as quickly as possible and to provide feedback to gematik and the manufacturer if improvements are necessary."
Feedback from practices already using the ePA varied greatly depending on the practice management system used. The medication list has proven to be largely positive so far. However, the problem of the lack of operational stability of the telematics infrastructure (TI) is not unique to the ePA, which is why the KBV has requested gematik to review all processes in this area.
If the ePA becomes mandatory on October 1, at least 99 percent availability of the TI will be necessary. "Anything else jeopardizes trust and acceptance in applications such as the ePrescription and the ePA," Steiner said.