In statutory health insurance (GKV), income still does not keep pace with expenses. This is shown by the preliminary figures for last year published by the Federal Ministry of Health. Accordingly, the cost explosion continues.
According to the information, there was 355.9 billion euros in income compared to expenses of 352.4 billion, so the GKV recorded an increase. But while expenses rose by 7.8 percent, contribution income only increased by 5.3 percent. The final results of the health insurance companies for 2025 and the first quarter of 2026 are expected in mid-June.
This long-standing development leads to constantly increasing contributions for the 74 million people with statutory health insurance and thus to a declining net income. The trend is also reflected in the economic balance of employers, half of whom pay for the statutory health insurance of their employees.
Federal Health Minister Nina Warken (CDU) reiterates that she wants to keep contributions stable, but she also said: “From 2027 onwards, financing gaps in the GKV are expected to run into double-digit billions every year.” Which areas are driving up healthcare costs? Where should savings be made? Here is the overview.
Health insurance executives collect more money
There are 93 statutory health insurance companies in Germany, each with its own administration. The expenditure on this amounted to 13.3 billion euros last year. That was around 602 million euros or 12.7 percent more than in 2024.
The so-called material administrative costs rose by 4.4 percent, the personal ones even increased by six percent. This includes salaries, wages, social security contributions and pension benefits for the employees who are responsible for advice, application processing, benefit accounting and membership administration.
All funds also have their own board of directors. According to a report in the Bild newspaper, their salaries have risen sharply in some cases. The new CEO of BKK firmus is said to have received an increase of 31,424 euros last year compared to his predecessor’s salary. The BKK firmus currently charges the comparatively lowest contribution.
According to Bild, the biggest jump is made by the head of the Bahn-BKK, whose salary increased from 178,750 euros to 195,000 euros, plus a bonus of 44,688 euros. At the end of 2025, the Bahn-BKK increased its additional contribution by 1.2 percentage points to 3.4 percent. Board members of other funds also received more money last year.
Meanwhile, the costs of statutory health insurance for services increased by a total of 24.6 billion euros last year, which corresponded to an increase of 7.9 percent. The GKV therefore spent 336.4 billion euros on its actual tasks.
The health insurance companies still spend most of their money on treatment in hospitals. This time they were once again the largest cost driver with a total of 111.4 billion euros, 9.7 billion more than in 2024.
According to the Ministry of Health, this increase of 9.6 percent was more than twice as large as the annual average during the period between 2013 and 2024. The concentration of inpatient care, specialization and greater integration of outpatient structures are intended to slow down the ongoing development. Critics consider it questionable whether the hospital reform in the form now adopted will achieve these effects.
Not only did expenses for inpatient treatment increase sharply, but also those for the outpatient sector, namely by 3.8 billion euros or 7.6 percent. In addition to the increased remuneration for contracted medical and psychotherapeutic care, according to the Ministry of Health, outpatient operations led to an additional financial outlay of 15.7 percent, as did outpatient specialist medical treatment (16.3 percent), treatment in university outpatient clinics (8.9 percent) and specialized outpatient palliative care (15.2 percent).
The cost of medicines is rising sharply
Medicines continue to rank ahead of the outpatient sector in second place on the expenditure list. They corresponded to almost half the cost of hospital treatment. The GKV spent 58.5 billion euros, 3.2 billion more, on this. The increase was 5.9 percent, which was also above the annual average between 2013 and 2024.
The GKV spent around 14.7 million euros on medicinal products, 10.4 percent more than in the previous year. Remedies include non-drug treatments that relieve pain or are prescribed for limited mobility, such as physiotherapy (557 million euros in 2025) or occupational therapy (439 million).
What does this mean for those with statutory health insurance? For them, the general contribution rate remains stable at 14.6 percent. On the other hand, the additional contribution varies depending on the health insurance company. The average estimated additional contribution of 2.9 percent already represents a significant jump compared to 2025 with only 2.5 percent. Overall, insured people pay an average of 17.5 percent of their gross income, half borne by the employer and half by the employee. The range of contributions overall ranges from 16.78 to 19.0 percent.
