Are there any less than 60 health insurance companies?

Statutory health insurance

System under pressure: soon 30 instead of 90 health insurance companies?

The statutory health insurance companies drift apart. A new analysis shows that smaller coffers in particular lose ground, while large ones benefit.

The additional contributions in statutory health insurance (GKV) are increasingly different from cash on cash – with consequences, especially for smaller health insurance. This emerges from the “GKV check-up 2025” of the management consultancy McKinsey, which is available to the “Handelsblatt”.

Anyone who has lost members in the past and had to increase the contributions continues to lose their attractiveness. However, larger providers who have had stable contribution rates and increasing membership numbers continue to grow – such as the Techniker Krankenkasse (TK). Their board member Jens Baas told the “Handelsblatt”, the TK now counts around twelve million insured-this corresponds to about 16 percent of all GKV insured.

The financial situation of the statutory health insurance companies is generally tense: a deficit of around six billion euros is expected for 2024 – significantly more than forecast. The causes: According to McKinsey, hospital stays and medication have become around nine to ten percent more expensive.

“With adjustments to the additional contributions, health insurance companies can partially compensate for the increased costs,” explains Stephanie Schiegnitz, partner at McKinsey and editor of the check-up. However, some cash registers have already exceeded the four percent brand. In addition, the trend is going to rehearse at the contribution rate even during the current year – and not just once at the turn of the year. Last speaking at the BKK Firmus, the cheapest nationwide open health insurance in Germany.

Many health insurance companies can hardly access reserves. Actually, they are intended to help with bottlenecks – for example, if the expenses increase significantly as currently. However, under ex-health minister Jens Spahn (CDU), it was legally prescribed that reserves must be dismantled above a certain monthly edition. In 2023, the total amount of the reserves was eight billion euros – in 2019 it was even more than twice as much.

At the same time, the cash death continues: there were still over 1,800 statutory health insurance in 1970, today there are only a good 90. Health economist David Matusiewicz from FOM believes that the target size of 30 to 40 health insurance companies required by former Minister of Health Ulla Schmidt should soon be achieved.

At the same time, the structure of the insured changes. In the meantime, 46 percent of the legally insured persons are over 50 years old – which in turn causes performance expenditure to increase. The so -called risk structure compensation should actually be compensated. Through it, health insurance companies with many sick and older insured persons receive more money than those with boys and healthy. Sometimes this mechanism only worsens the split between the health insurance companies. “Some coffers benefit – others with an unfavorable insured structure are pressed on the wall,” said Matusiewicz.

In the coalition agreement, the Union and SPD agreed on the use of a commission. This is intended to evaluate the health policy projects of the coalition partners and, by spring 2027, propose specific measures on how statutory health insurance can be reformed.