On 1 March 2025, the Act to Strengthen Health Care (Gesundheitsversorgungsstärkungsgesetz) came into force, including important changes to the remuneration of general practitioners (GPs).
In the German Social Health Insurance system, the remuneration of ambulatory care physicians is subject to regional budgets that limit the number of services a physician can bill per yearly quarter. In addition to restricting service provision, the system has also meant that patients with ongoing treatment needs, such as those with chronic conditions, must visit their physician each quarter in order for the physician to be able to bill the related services.
With the new act, the Ministry of Health aims to expand primary care services by abandoning the volume ceilings for GPs and improving efficiency.
The act introduces the following changes [1]:
- All services provided by GPs will now be fully reimbursed without volume caps. A similar de-budgeting policy was already implemented for paediatricians in April 2023 (see country update “De-budgeting: new plans for pediatricians to be exempt from volume ceilings in ambulatory care” from 27 January 2023).
- GPs can now bill flat rates for patients with chronic conditions for up to four quarters at once, covering services for the respective disease.
- Flat-rate payments for basic services will be introduced, depending on factors such as practice opening hours and whether they offer home visits or care in nursing homes.
The political opposition and physician associations have mostly welcomed the law. However, the health insurance funds have voiced concerns about the projected additional costs, estimated at €400–€500 million per year and criticized the law for lacking incentives to expand the availability of services in areas with low physician density [2, 3].
The next step will involve negotiations among the self-governing associations to agree on how to implement the new regulations.
In addition to changing the GP reimbursement, the act also includes further measures [1]:
- Access to medical aids will be simplified for people with severe diseases or disabilities. A recommendation from a physician will now be sufficient for patients receiving treatment in specialized centres.
- The age limit of under 22 years for accessing emergency contraceptives will be lifted for victims of sexual abuse or rape.