Overview

• Federal spending on health aid for civil servants reached about €6.6 billion in 2024, up 14.8% compared with 2022, according to the Bundestag’s scientific service.
• State governments’ outlays climbed from €11.3 billion in 2022 to €13.8 billion in 2024, increasing pressure on Länder, municipalities and social insurance.
• Under the Beihilfe system, the state covers part of officials’ medical, nursing and preventive costs, and most purchase private insurance for the remainder.
• Greens lawmaker Linda Heitmann, who commissioned the report, criticizes the setup for bolstering private insurers and advocates fixed-sum employer support for those in statutory coverage.
• Several states such as Hamburg and Bremen offer a flat subsidy model that pays 50% of statutory contributions, with Hamburg data showing 16.5% uptake among new hires and 24.6% among junior staff from 2018 to 2023.