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Germany: Preliminary Financial Outcomes Unveiled by Statutory Health Insurance for 2023, reports surplus expenditure of ~€1.9 billion, largely attributed to legislative mandates | iPharmCenter

Updated: May 11

In their initial financial disclosures, the statutory health insurance providers reveal a surplus expenditure of approximately 1.9 billion euros for the year 2023. This surplus largely stems from legislative obligations under the GKV Financial Stabilization Act, mandating a transfer of 2.5 billion euros from the health insurance companies' financial reserves to the health fund in 2023. By the end of December, the financial reserves of these companies reached 8.4 billion euros, equivalent to 1.5 times the legally mandated minimum reserve, which stands at 0.2 times the monthly expenses.


Meanwhile, the health fund reported an anticipated deficit of 3.3 billion euros in 2023, with a liquidity reserve of around 9.4 billion euros as of January 15, 2024.

Totaling 304.4 billion euros, the statutory health insurance companies' income was offset by expenses amounting to 306.2 billion euros.

Benefit and administrative costs experienced a 5.0 percent increase, paralleling a 0.9 percent rise in the number of insured individuals. At the conclusion of 2023, the average additional contribution rate levied by health insurance companies stood at 1.51 percent, slightly below the projected 1.6 percent announced for the year, as of October 2022.


Disparate Financial Trajectories Across Health Insurance Categories

In 2023, all categories of funds reported expenditure surpluses. Replacement health insurance funds recorded a surplus of 1.1 billion euros, followed by 363 million euros for company health insurance funds, 225 million euros for general local health insurance funds, 122 million euros for the Knappschaft, 24 million euros for guild health insurance funds, and 4 million euros for the agricultural health insurance fund.

Health Fund Outcome


The health fund posted a spending surplus of 3.3 billion euros in 2023. This deficit primarily arose from a provision within the GKV Financial Stabilization Act, which redistributed additional funds to health insurance companies by lowering the upper limit of the liquidity reserve. Consequently, the liquidity reserve stood at around 9.4 billion euros as of January 15, 2024. Anticipating further declines, additional funds of 3.1 billion euros are slated for distribution to health insurance companies in 2024. Premium income, excluding additional contributions, surged by 5.4 percent in 2023 compared to the previous year, largely driven by significant wage hikes due to inflation.


Expenditure Trends

In 2023, health insurance companies witnessed a 5.0 percent uptick in service expenditure and administrative costs, coinciding with a 0.9 percent rise in insured individuals. Performance expenses climbed by 5.2 percent, while administrative costs saw a 1.6 percent increase, indicating accelerated spending compared to 2022's figures, which saw a 4.2 percent increase. Despite measures outlined in the Financial Stabilization Act to curb expenditure, inflation-driven rises in personnel and material costs, as well as service provider remunerations, exerted pressure.


Hospital treatment expenses saw a significant increase of 7.0 percent, amounting to around 6.1 billion euros, with notable rises in inpatient psychiatric treatments and nursing staff costs.


Many smaller service sectors, including vaccinations and treatment care, experienced disproportionate spending growth. Expenditure on medicinal products rose by 9.1 percent, primarily due to enhanced remuneration for providers. Medical aids expenditure grew more dynamically at 7.3 percent, while sick pay expenditure rose by 6.4 percent. Notably, child sickness benefit expenditure decreased to around 470 million euros, attributed to the expiration of pandemic-related regulations in 2023.


Pharmaceutical expenditure increased by 2.9 percent, significantly lower than the overall service expenditure increase, marking the first time since 2018. This moderation can be attributed to regulations within the GKV Financial Stabilization Act, including an increased manufacturer discount for patent-protected drugs.


Interpreting the preliminary billing results necessitates consideration of estimated expenses in various service areas, especially for doctors and dentists, due to incomplete billing data. Predictions from GKV estimators in October 2023 indicated an average additional contribution rate of 1.7 percent for 2024, marking a 0.1 percentage point increase from 2023. Individual health insurance companies' additional contribution rates may vary.

As of January 1, 2024, 45 companies raised their contribution rates, 45 maintained theirs, and four reduced them, resulting in an average additional contribution rate across the statutory health insurance system of 1.7 percent.

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