Doctor's appointment for payment - why the initiative is causing outrage

FAQ Debate about appointments for money When the doctor sits behind the payment barrier As of: November 15, 2026 • 1:42 p.m

See a specialist faster - but only if you pay for the treatment yourself: Gassen, head of the statutory health insurance physicians, has sparked widespread criticism with his statements about appointments for an additional charge. What is the situation for statutory health insurance patients - and what are politicians doing?

Germany's healthcare system is considered expensive, inefficient - and unfair. While private patients can get a doctor's appointment quickly, statutory health insurance patients often have to wait a long time. The black-red coalition wants to create more fairness here, but there is no concrete information yet. However, the austerity package in the healthcare system is very concrete. The Statutory Health Insurance Contribution Stabilization Act was passed in July and the measures should apply from 2027. The package includes spending curbs in practices, clinics, pharmacies and the pharmaceutical industry - but also higher co-payments for medication and restrictions on free co-insurance for spouses.

Since then, various lobby groups have been mobilizing, with statutory health insurance doctors in particular warning of cuts in patient care. Recent statements by the head of the Association of Statutory Health Insurance Physicians, Andreas Gassen, caused a stir, according to which quicker doctor's appointments for statutory health insurance patients could soon only be available for an additional charge. The outrage is - as expected - great.

According to Andreas Gassen, head of statutory health insurance physicians, those with statutory health insurance must be prepared to pay for treatments out of their own pockets due to fee cuts - in order to avoid longer waiting times. A payment barrier for doctor's appointments, like the one that already exists for private consultations. “People with statutory insurance who choose this option are then treated like a private patient outside of statutory insurance, but have to pay the costs out of their own pocket as self-payers,” explained Gassen in an interview with the RND. Nobody could expect that the practices would simply carry on as before in view of the cuts. Gassen spoke of fee cuts amounting to three billion euros. The areas of ENT, orthopedics, cardiology, radiology and rheumatology are particularly affected.

If you want to avoid longer waiting times, you have to pay for treatments yourself, according to the head of the statutory health insurance company. more

The federal government's savings program for statutory health insurance provides for extensive savings measures, including in the remuneration of doctors. For example, the fee bonus for quicker appointment allocation was partially withdrawn. With the Appointment Service and Care Act (TSVG/2019), doctors were granted additional remuneration in certain cases when appointments were made. Despite the corresponding billions in additional expenditure, it was "not achieved" to reduce waiting times, as the Federal Audit Office found in February. According to the KBV, the loss of the so-called TSVG remuneration means a loss in fees of around 1.64 billion euros per year for practices. Overall, the planned cuts in the outpatient sector for the coming year alone amount to around 2.7 billion euros.

But the truth is also: Doctors and health insurance companies have just negotiated a fee increase of 2.2 percent for 2027, which, according to the National Association of Health Insurance Funds, amounts to 1.1 billion euros more.

The criticism of the statements made by the head of statutory health insurance physicians is unanimous - and it comes from politicians as well as from statutory health insurance companies and social associations.

A development towards “paywall medicine” would be highly problematic from a medical and socio-political point of view, said Janosch Dahmen, health policy spokesman for the Bundestag faction, to the dpa news agency. "I strongly warn against the fact that a new three-class care system is establishing itself in Germany alongside the existing two-class medicine." A supply bottleneck should not become a business model.

Vice Chancellor and SPD leader Lars Klingbeil made it clear on the sidelines of an event in Potsdam that “such a proposal cannot be made with us.” Statutory health insurance patients should not have to incur additional costs. He referred to the appointment guarantee agreed by the coalition for specialists who should receive statutory health insurance patients.

See a specialist faster if you pay for the appointment yourself? This scenario sparks criticism. more

Sharp criticism also came from the umbrella association of statutory health insurance companies. There was talk of a “fear campaign”. “Here, people with statutory health insurance who need a doctor are being held hostage so that doctors can increase their fees. This is scandalous behavior,” said the deputy chairwoman of the GKV board, Stefanie Stoff-Ahnis. "Doctors in private practice receive an average of over 200,000 euros per year from their medical practices. There is no indication that this will change in the coming year."

The Social Association of Germany (SoVD) rated the initiative as “highly lacking in solidarity and socially unfair”. The board of the German Foundation for Patient Protection, Eugen Brysch, reminded the statutory health insurance associations of their legal mandate to ensure safety. The medical association must be measured by this. "Instead, the chief lobbyist refers to private payments. So supply becomes a question of wallet."

... for statutory health insurance patients. The black-red coalition wants to remedy this despite all the austerity measures. Health Minister Carsten Linnemann wants to present a major reform of medical care this year. The CDU politician announced in the Bundestag in September that the draft for a primary care system should see the light of day “this year, probably in November”.

The stated goals of the reform: shorter waiting times for specialist appointments and more efficient care. More targeted patient control according to the maxim: usually first go to the family doctor's practice should help. The practice will then refer you to specialists if necessary and with an appointment within a certain period of time.

Another law has already brought medical appointments into focus. Attached to the recently passed emergency reform, an obligation was introduced for contracted doctors: They must report appointments to the existing appointment service points (116 117). KBV boss Gassen recently criticized this and warned of even longer waiting times. The fact that doctors' practices will have to report a fixed number of free appointments in the future will not mean that patients can get appointments more quickly, said Gassen. “On the contrary: If a fixed contingent of appointments to be reported is set and these are blocked in the practices, they will no longer be available to the patients in these practices,” said the head of the statutory health insurance physicians. “Only if more money is available for outpatient care will there be more appointments.”

This topic in the program: tagesschau.de | Do statutory health insurance patients have to pay more themselves? | 11/14/2026 | 8:12 p.m. Tagesschau24 | News | 11/14/2026 | 9:00 am