General medicine | Austerity law as a black box

To relieve the burden on family doctors, even more qualified nursing staff could be deployed in the future - like here in the Spreewald in Brandenburg. Photo: dpa/Patrick Pleul Because of the GKV savings law passed in July, family doctor's practices - and thus their patients - are also facing changes. What this means is not yet completely clear. However, budgeting shows how quickly politically promised improvements are withdrawn. From October 1, 2025, the budget limits for most primary care services will no longer apply. This means that since this date, doctors have received full reimbursement for almost all treatments and examinations within the legal framework without any compromises. Actually, the political promise is that it should stay that way permanently.

Only a few specific services, including pain therapy, remain capped. But that is now changing again. In the future, services above certain limits will only be paid on a staggered basis: It is possible, for example, that 800 patients with a respiratory infection are treated, but the fee only applies to 600 patients.

Remuneration restrictions tend to be a deterrent for young doctors to set up practice.

Further reductions result from the fact that the total compensation for all outpatient services may only grow as much as the basic wage rate. The upper limit for 2027 has already been set at an increase of 3.42 percent - but this value has already been artificially reduced by one percentage point. The medical profession is right to criticize this - because the actual medical needs (of an aging population) are not based on the income of the health insurance companies subject to contributions. In addition, practices have little opportunity to fully refinance growing costs - including salaries for their medical assistants or for energy.

In addition, special rules no longer apply, including additional reimbursements, if patients were accepted and cared for via the statutory health insurance appointment service. It is still unclear whether there should actually be discounts for family doctor-centered care - then more newly registered patients could mean less fees instead of more in the future. From the doctors' point of view, the very model that will become even more important in future care and should actually control it efficiently is being punished.

Under these circumstances, the Association of General Practitioners, among others, warns of “permanent damage to care.” In other words: There will be fewer available appointments and longer waiting times - especially for scheduled services. This includes regular follow-up checks for chronic illnesses, with which more and more older patients are going to their family doctors. Open acute consultation hours could also be shortened. Overall, the search for a family doctor is unlikely to become any easier, especially in rural areas. The restrictions on remuneration tend to be a deterrent for young doctors to establish themselves.

A family doctor in Brandenburg describes the new requirements as a black box: “We don’t know what’s happening. I'm afraid it will be worse than we can imagine now.'

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