Is a Spending Freeze Sufficient to Stabilise the Contribution Rate in Germany’s Statutory Health Insurance? A Counterfactual Simulation

If this trend continues, further increases in contribution rates will be unavoidable. A change of health policy to ensure that spending is based on revenues is therefore urgently needed. One of the strategies currently being called for is a spending moratorium which would limit future increases in statutory health insurance expenditure to the growth in revenue from members’ compulsory contributions. That this will not suffice, however, is shown by the fact that the statutory health insurance membership will already have aged significantly by the end of the current legislature in 2029. A counterfactual simulation shows that while the rising proportion of pensioners with statutory insurance will not shrink the total amount of wages and salaries subject to compulsory contributions in that period, the growing number of insured in the higher age groups, on which more is spent, will lead to a latent increase in expenditure by 2028. If the contribution rate is to be stabilised during the current parliament, this impact on outgoings must be neutralised, to achieve which, expenditure per insured person increases must be kept 0.4 percentage points below the annual rise in contribution revenue.