The unbroken spending dynamic for health care in Germany is countered by a number of political reform projects that, among other things, want to better channel access to emergency and outpatient care.
Start instead of waiting
Table of Contents
It is undisputed: demographic developments and the (over-)use of local medical care, as well as medical progress, make prioritization and the increased use of digital offerings more necessary than ever. At the same time, there is so far not only a reform that would eliminate the imbalance between income and expenditure of statutory health insurance companies, but also a public health strategy that could relieve the health system in the long term through joint preventative measures.
Although there are still strong demands on the legislature in many places, there are already opportunities for statutory health insurance companies to address the needs of the insured better than before and at the same time to address the dynamics of spending in the long term. To this end, statutory health insurance companies need to take on more of the “pilot role” in the health system that is demanded by insured people.
An active approach to insured persons, an increase in health literacy, cross-sector care approaches and, last but not least, the creation of a symbiosis of analogue care on site and digital options are the drivers of this understanding of roles.
A look at Saxony-Anhalt – a model region
Saxony-Anhalt, as the federal state with the “oldest population”, is particularly dependent on innovative supply solutions. Due to its demographic development, the federal state is often cited as a model region for expected developments in Europe. To put it positively: In Saxony-Anhalt it will be visible how health and nursing care as well as prevention strategies can be successful.
In the here and now, however, a large number of known risk factors lead to the lowest life expectancy nationwide and, for many illnesses, to inglorious “top rankings” in the AOK Health Atlas. Metabolic diseases, musculoskeletal diseases and especially cardiovascular diseases: the population of Saxony-Anhalt is particularly affected.
Men live longer in the southwest than in the east.
The consequence of this frequency of illness is strikingly summed up by a comparison often quoted in the media: “Men live longer in the southwest than in the east” was the headline of the online portal “Zeit” in the summer of 2025 and referred to statistics according to which the life expectancy of men in Baden-Württemberg is four years higher than in Saxony-Anhalt.
A pressure to act that is weighing on the health system and has long since transformed AOK Sachsen-Anhalt from a “payer to a player”. It is no coincidence that a family doctor-centered care program has existed in Saxony-Anhalt for over 20 years, in which 95 percent of family doctors participate and which has positive effects on the care situation. The controlling role of the “primary doctors” remains essential. At the same time, their (time) resources are limited, which increases the demand for a further educational and navigating role in the healthcare system.
Use data and creative freedom
The challenges outlined for the federal state can of course also be found in the routine data of AOK Saxony-Anhalt. If we focus on cardiovascular diseases as an example, it can be seen that of around 156,000 insured people who were already suffering from high blood pressure in 2017, 46 percent of them developed a secondary illness just six years later. Serious numbers – these also include heart failure, kidney disease or atrial fibrillation.
The causes of these secondary diseases are often lifestyle-related and can therefore be influenced. For AOK Sachsen-Anhalt, the aim is not to accept this as an unchangeable course, but rather to inform insured persons according to their respective needs and to make tailor-made offers. Healthy insured people will always have different expectations of their health insurance company than those with a single diagnosis or insured people who have a chronic illness.
But how can insured persons receive precisely tailored information and offers that achieve the desired results? A look at the social security code shows the possibilities. With the regulations in § 25b and § 68b in SGB V, existing options for statutory health insurance companies to structure care were supplemented in such a way that individual care management for statutory health insurance companies was simplified.
They should take advantage of the options that statutory health insurance companies have, as this corresponds to the expectations of those insured. The current digital health study by the management consultancy Ernst & Young shows: 66 percent of those surveyed expect health insurance companies to take on an “active guide role” that navigates them through the individual stages of the health system, 73 percent see their statutory health insurance company as a contact person when asked about optimal health care.
Existing care campaigns by AOK Sachsen-Anhalt, which meet these expectations and take advantage of the opportunities provided by SGB V, confirm broad acceptance among insured persons. A digital “high blood pressure coach” offered by the AOK Federal Association is already valuable support for high blood pressure patients. The focus is on building knowledge – i.e. building health literacy.
Support through smartwatch and teledoctor
When the disease is already advanced, hybrid care offerings are met with great acceptance. AOK Sachsen-Anhalt insured persons who have already been diagnosed with atrial fibrillation and who have undergone treatment (catheter ablation or cardioversion) can be equipped with a smartwatch that enables ECG recording and regular heart rate recording. If there are any abnormalities, a teledoctor and of course also the available outpatient and inpatient care provide support. This confirms the potential of using data that is only available to this extent from statutory health insurance companies. By directly addressing those insured who already have atrial fibrillation, take-up of the care offer was tripled compared to an application “only” by the service provider.
The high response to an offer tailored to the individual health situation of the insured also shows the great need for orientation. Unfortunately, regardless of the stage of the disease, this is accompanied by a low level of health literacy. Studies showing that three quarters of adults have insufficient health literacy show the explosiveness of the issue. Promoting this remains important at every “care level”. This is an important building block for increasing the quality of life of the insured and relieving the burden on the health system.
They should take advantage of the options that statutory health insurance companies have, as this corresponds to the expectations of those insured.
Avoiding unnecessary doctor contacts, inpatient stays and improving treatment adherence are important goals, not only from a spending logic of “payers”. The limited analog resources in medical care require informed insured persons and patients who can better find, evaluate, understand and also implement information on clinical pictures. This means that health insurance companies should think about care across sectors and position themselves in such a way that individual care management along the patient path is possible. Taking advantage of the opportunities offered by digitalization and establishing a connection to regional care structures is already possible today, especially for regionally active health insurance companies with in-depth knowledge of local care structures.
The fact that statutory health insurance companies, such as AOK Sachsen-Anhalt, are more active in their care management not only corresponds to the wishes of the insured, but is also “in the DNA” of statutory health insurance companies, which are intended to ensure needs-based, quality-assured and economically expedient care. In this role, they will only ever be successful in partnership with other actors (service providers, municipalities, etc.).
The incentive for this should not only be great in the “model region” of Saxony-Anhalt. The aim is to translate the highest health expenditure per capita in the EU into more healthy years of life across Germany. To do this, it is important to use the opportunities that SGB V already offers today. At the same time, the accuracy of the offers desired by insured parties also requires faster availability of (billing) data for statutory health insurance companies. This demand on the legislature remains just as relevant as the implementation of intersectoral care.
Corinna Sache (DGIV, AOK Saxony-Anhalt)
2026. Thieme. All rights reserved.