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KBV Floats Paid Specialist Access as Parties Press Competing Fixes for GKV Finances

The coalition is moving to a GP‑first model, with the health minister open to discussing fee‑based options.

Overview

  • KBV chief Andreas Gassen proposes a “Facharzttarif” of about €200–€350 per year to let insured patients see specialists without a GP referral or digital triage, which is not government policy.
  • Gassen argues the tariff revenue would finance additional specialist appointments paid outside existing budget caps, noting many specialist services are currently only about 80 percent remunerated.
  • Greens and Left leaders warn the plan would entrench two‑tier access and disadvantage lower‑income patients, urging structural reforms and a modern primary‑care gatekeeping model instead.
  • Union figures push broader financing shifts, including fully tax‑funding ‘versicherungsfremde Leistungen’ of roughly €57 billion and, in some proposals, penalties for bypassing GPs, alongside support for a binding Primärarztsystem.
  • Financial strain remains acute, with the GKV posting a 2024 deficit of roughly €6–6.7 billion as Minister Nina Warken seeks a €4 billion federal top‑up, the CDU Wirtschaftsrat urges more out‑of‑pocket payment for dental and orthodontic care, and insurers call for an expenditure moratorium.