Self-paying in doctor's offices: The path to three-class medicine

There are statements that come across as pragmatic. And in reality they represent a turning point. The announcement by the head of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen, about future appointments in doctors' practices belongs to this category. Gassen has now explained in an interview that there will be fewer appointments for patients with statutory insurance in the future because the austerity law provides for cuts in doctor's fees for patients with statutory insurance from 2027. Doctors will therefore offer more private consultations, he announced. This is also an alternative for those with statutory health insurance who, as self-payers, would then have to “pay the costs for the treatment out of their own pocket,” said Gassen.

When the top boss of statutory health insurance physicians announces privately paid doctor's visits as an alternative for those with statutory health insurance who would otherwise have to rush after an appointment, then something is getting out of hand in the health system. Employees with a middle income cannot even voluntarily switch to a private health insurance company, but are compulsorily insured with Barmer, AOK & Co. Despite increasing contributions, they will receive increasingly poor performance in the system if they are not prepared to spend a few larger bills in order to get a more timely appointment with an orthopedist or rheumatologist.

Today, the practice can already be seen on the digital communication platform “Doctolib”. If you click on the “Appointments for those with statutory health insurance” category, you will receive a short list of specialists who offer longer-term appointments, if at all. If you click on the “Appointments for privately insured and self-paying” category, a longer list of doctors opens with the coveted blue fields for prompt online appointment booking. By the way, Doctolib only recently introduced the “self-payer” category in this form.

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This is the trend towards three-class medicine. At the top are high earners and civil servants who are privately insured. At the bottom are those with statutory health insurance who don't have enough money to pay horrendous self-pay fees. In the middle are those with statutory health insurance who can afford to pay extra if they don't want to know for two months whether the pain in their joints is the beginning of rheumatism.

If there is a trend towards compulsory self-payment for those with statutory health insurance, politicians will come under pressure. Not only the statutory health insurance funds, but also the separation between private and statutory ones are being put to the test. That would actually be good.