Statutory health insurance (GKV) is in deep financial trouble. Your members notice this through increasing contributions. There are no far-reaching reforms in sight. Instead, a slow seller comes along in a new look.
Andreas Gassen brought it into the discussion. The chairman of the board of the National Association of Statutory Health Insurance Physicians (KBV) suggests that patients should in future pay a fee every time they visit a practice. He thinks two or three euros is justifiable. There was something similar before: ten euros per quarter. The administrative burden was high, the effect was small, and the regulation was abolished at the end of 2012 after eight years.
Meanwhile, Gerald Gaß suggests doubling the additional payment per hospital stay by ten to 20 euros. Like his KBV colleague, the head of the German Hospital Association (DKG) wants to relieve the financial burden on the coffers. Both measures have one thing in common: they would hit people with low incomes harder than high and higher earners. They came at the expense of those who cannot defend themselves.
The income from the statutory health insurance does not cover the needs, even though the contributions are increasing at ever shorter intervals, because at the same time expenses are increasing from year to year. Now another post is added.
From April, heavy smokers can take part in a lung cancer screening using computer tomography every twelve months. The examination will be included in the GKV’s catalog of services. The offer is aimed at people between 50 and 75 years of age who have consumed tobacco for at least 25 years and 15 so-called pack years, which corresponds to at least 20 cigarettes a day over this period.
In this way, tumors should be detected early. This is very welcome. In Germany, more than a quarter of the population smokes. For children and young people between the ages of 12 and 17 it is at least seven percent. Around 57,000 people develop lung cancer within a year, mostly caused by long-term and heavy smoking of cigarettes. What is interesting from an economic perspective are the follow-up costs that arise as a result: according to estimates, they amount to around 100 billion euros annually.
This also puts pressure on the fund’s budget and thus on the contributions of its members. It actually makes sense to use their money to limit the financial damage – through prevention in computer tomography.
As we all know, health is more important than money. It would make even more sense to prevent people from picking up cigarettes in the first place: through the price. In industrialized countries, a tax increase of ten percent reduces tobacco consumption by four percent. The German Cancer Research Center (Dkfz) points this out. The revenue from the tobacco tax in this country is 15 billion euros, which is small compared to the 100 billion euros in follow-up costs. Nevertheless, tax increases have recently been modest. Why?
Does the tobacco industry influence politics?
In 2025, the Dkfz conducted an analysis of the tobacco industry’s influence on political processes. Among other things, it concludes: “Based on the limited publicly available information, it is likely that the tobacco industry has opportunities to influence political decisions.”
This applies, for example, to taxes on tobacco products and e-cigarette liquids as well as a potential ban on disposable e-cigarettes. And: A “tightening of marketing restrictions” planned by the federal traffic light coalition before 2024 never reached the status of a draft, according to the Dkfz in its conclusion.
Lung cancer prevention and its financing are just one example. It represents all the hurdles that would have to be overcome in order to fundamentally reorganize the health system in a socially acceptable and cost-effective manner. That would be urgently needed, after all it is the most expensive in all of Europe in terms of economic output. Its share of the gross domestic product is twelve percent, in absolute figures around 500 billion euros per year. The GKV spends more than 300 billion.