Statutory health insurance
Practice fees get new tailwind
October 29, 2026 – 12:39 p.mReading time: 3 minutes
An old idea is making a comeback to restructure statutory health insurance. Germany’s neighbors serve as role models.
“Ten euros, please”: Anyone who went to see a doctor between 2004 and 2012 regularly had to take out their wallet. One from the red-green party at the time Federal Government The practice fee adopted stipulated that patients had to pay ten euros per quarter for their first visit to a doctor. The federal government hoped to avoid unnecessary visits to the doctor and thus reduce the costs of statutory health insurance (GKV). In 2012, the federal government ended the experiment: the hoped-for effects were too small and the bureaucratic effort for doctors was too high.
Practice fees could make the healthcare system more efficient
Now a new study by the Scientific Institute of Private Health Insurers (WIP) advocates reconsidering the introduction of deductibles in statutory health insurance. These could lead to more efficiency in the health system, strengthening personal responsibility and stabilizing statutory health insurance finances, it says. According to model calculations, a fee of 15 euros could reduce the contribution rate in statutory health insurance by 0.7 percentage points.
Other countries charge fees
If politicians actually want to control patients better, a practice fee would have to be designed differently – for example as a fee per doctor’s visit or as a penalty fee if the patient leaves the prescribed treatment path. As a possible model here could be Denmark serve. In the neighboring country to the north, patients generally do not pay any co-payment to their assigned family doctor. However, if the patient chooses a different treatment option, additional costs may arise. In the Netherlands, however, insured people pay the first 385 euros (in the future 400 euros) of the treatment costs themselves – only family doctor visits are excluded from this. Co-payments should therefore always be part of a larger concept, such as a primary doctor system, argues the WIP.
At the same time, the WIP warns against seeing a practice fee as a pure source of money for the GKV. Anyone who only looks at the money risks serious medical and social side effects. For example, chronically ill people or people with low incomes could forego medically necessary treatments due to financial constraints. The WIP therefore advocates load limits, such as in Swedenout of.
Insured people there generally have to pay an additional payment of varying amounts (between 18 and 41 euros) every time they visit a doctor. However, an annual upper limit of around 129 euros limits the costs. There is also already a limit in German law with Section 62 SGB V.
This applies in Germany
In Germany, the level of the burden limit depends on the respective gross income of a household. The limit is two percent. If this is exceeded, insured persons no longer have to pay their own contributions for medication or hospital stays. For those with chronic illnesses, the annual exposure limit is one percent of their annual gross income.
The WIP concludes that well-designed and appropriately structured deductibles are fundamentally to be advocated from a health economics perspective.
