Health policy in six questions

The data. Health expenditure reached €538.2 billion in 2024, or €6,444 per person and 12.4% of GDP. Destatis estimates €579.5 billion for 2025, an increase of 7.7%. Real, price-adjusted growth was 3.9% in 2024. So spending is rising faster than prices and much faster than the economy: real GDP grew by just 0.2% in 2025. The statutory funds spent €352.4 billion in 2025, 7.8% more than the year before. Hospital treatment alone rose by about 9.6%.

The competing views. There is no technically “correct” share of GDP for health. One camp argues that an ageing, wealthy society will rationally spend more on health, so the task is to finance the growth fairly. A second camp, strong among economists and insurers, argues that Germany spends more than comparable countries without matching outcomes. It points to high hospital capacity, a bed occupancy rate of just 72.0% in 2024 (Destatis) and limited patient steering. A third view, common among providers, says the real problem is underfunding of particular sectors, from rural practices to nursing care, rather than total spending.

Linnemann’s position. He falls clearly in the efficiency camp. In September 2026 he told the FAZ that Germany has a strong system that must become more efficient, and he said he wanted contribution rates eventually to fall. He has not proposed a spending ceiling. His tools are steering (Proposed primary-care system), cost containment (In force stabilisation law, inherited, and a Proposed second savings law) and less bureaucracy. Critics, including opposition health politicians, warn that efficiency targets without a clear benefit guarantee can turn into rationing.

The data. GKV members pay a general rate of 14.6% of gross wages, split between employee and employer, plus a fund-specific additional contribution (Zusatzbeitrag). The official average for 2026 is 2.9%, but on 1 January 2026 the funds actually charged 3.13% on average (BMG). Long-term care insurance adds 3.6%, or 4.2% for childless members. Contributions are paid only up to an income ceiling, and only on earnings, not on rents or capital income. The federal government pays a subsidy to the health fund and, under the stabilisation law, more for recipients of basic income support. About 74.6 million people are insured in the GKV (mid-2026). Most of the rest are in private insurance (PKV).

The competing views. The SPD, the Greens and the Left have long favoured a “citizens’ insurance” (Bürgerversicherung), bringing everyone into one system and widening the contribution base. Supporters of the dual system argue that PKV competition drives innovation and that ending it would raise serious constitutional and transition problems. Economists of several schools propose moving more of the costs that are not strictly insurance, such as family co-insurance and payments for benefit recipients, onto taxes. Employers stress the effect of contributions on labour costs.

Linnemann’s position. His guiding principle is that employees and employers must not be loaded with ever-higher non-wage labour costs (budget speech, 10 September 2026). Political position In the Bundestag on 23 September 2026 he rejected abolishing the PKV, citing constitutional concerns and the system’s openness to innovation. He suggested instead applying GKV decisions to civil servants’ Beihilfe scheme. Open question The 2027 average additional contribution is not yet set; the estimators’ group meets on 15 October 2026. Read health financing for the full picture.

The data. Germany had 1,841 hospitals with 472,900 beds in 2024 (Destatis). Inpatient cases were 17.5 million, still 9.6% below 2019. Quality research and the government’s hospital commission have argued for years that complex procedures belong in centres with enough experience and staff. The hospital reform (KHVVG, In force since 1 January 2025, inherited) introduces nationally defined service groups (Leistungsgruppen) with minimum requirements, which the Länder assign to hospitals.

The competing views. Supporters of concentration argue that it improves outcomes and makes scarce specialists go further. Länder governments and rural MPs warn about longer journeys and the loss of local hospitals. Their pressure led to the 2026 amending act (KHAG, In force since 15 April 2026), which allows more exceptions and moved the new standby payments back to 2028. Doctors and nursing organisations add a second point: quality depends on staff time, and documentation takes up too much of it.

Linnemann’s position. His third guiding principle is that doctors and nurses should have time for patients, not forms. At the hospital summit on 22 September 2026 he announced a Proposed bureaucracy-reduction law to cut duplicate inspections and introduce risk-based checks. He has not announced any change to the service-group system. Read hospitals for the details.

The data. In 2024, 16.7 million people were aged 67 or over. Destatis projects 20.5 to 21.3 million by 2038. The old-age dependency ratio (people 67+ per 100 aged 20–66) was 33 in 2024 and could reach 43 to 61 by 2070. Recipients of social long-term care insurance benefits rose from 2.67 million in 2015 to 6.01 million at the end of 2025 (BMG). Part of that rise reflects the broader definition of need introduced in 2017. Destatis expects demand for nursing staff to rise by a third to 2.15 million by 2049.

The competing views. Some argue for building up more capital-funded reserves for care costs. Others want tax funding for tasks of society as a whole, such as pension credits for family carers. Still others want a cap on what residents pay themselves in care homes. Experts across camps call for more prevention and rehabilitation to delay the need for care. Trade unions and nursing associations focus on pay and staffing as the real bottleneck.

Linnemann’s position. He has called the finances of long-term care insurance disastrous, with an expected deficit of €8 billion in 2027 and more than €15 billion in 2028, and warned that without fundamental reform the system would collapse in the 2030s (FAZ, September 2026). The cabinet’s care bill (PNOG, Proposed, 30 September 2026) keeps the general rate at 3.6%, raises the surcharge for the childless and indexes benefits from 2029. An expert commission (Under review) is working on structural reform. Read nursing and demographic change.

The data. GKV drug spending reached €58.3 billion in 2025, up 5.7% (vdek, BMG data). Since 2011 the AMNOG procedure has tied the price of new medicines to their proven added benefit. According to the GKV-Spitzenverband it produced negotiated savings of €10.3 billion in 2024. The stabilisation law raises the general manufacturer discount to 15.5% (In force, inherited). Digitally, the electronic patient record for all, with about 73 million records by April 2026, and the GDNG data law (in force since March 2024) are building the basis for research use of data.

The competing views. The pharmaceutical industry argues that rising discounts and price rules make Germany less attractive for launches and research. Insurers argue that prices for new patented drugs are the fastest-growing cost item and that AMNOG must be tightened. Researchers and patient groups want faster access, both to new treatments and to health data, with strong data protection. Shortages of older, low-cost generics are a separate problem: 1,514 shortage reports to BfArM in 2025 (Zi).

Linnemann’s position. In defending the dual insurance system he stressed innovation. He has committed to completing two bills inherited from his predecessor: the registry law (Medizinregistergesetz, Inherited · in the Bundestag) to make registry data usable for research, and the digital-health bill GeDIG (Inherited · first reading 8 Oct 2026). He has not taken a public position on AMNOG reform. Read pharmaceutical policy and health innovation.

The data. Waiting times for specialist appointments are a recurring complaint. Reporting on the planned primary-care system cites averages of 36 to 41 days. At the end of 2025, 23.4% of the roughly 446,000 practising physicians were aged 60 or over (German Medical Association), so a wave of retirements is coming. Pharmacies, emergency departments and the 116 117 on-call service are all under pressure. In rural regions the issue is distance as well as time.

The competing views. Supporters of a primary-care model say that a coordinating first point of contact frees specialist capacity for those who need it most. Critics, including some specialists’ associations, fear an extra hurdle and limits on free choice of doctor. A separate debate concerns the gap in waiting times between GKV and PKV patients, which the Chancellor raised in parliament. Linnemann answered that proposals to regulate this ran into constitutional problems.

Linnemann’s position. His first guiding principle is that anyone who needs medical help must get to the right place quickly. The primary-care draft (Proposed, promised for November 2026) and the emergency-care reform (Inherited, in parliament) are his main tools. He also wants pharmacies to play a bigger role in guiding patients. Read medical workforce and digital health.