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October 6, 2026
Moira Hammes
Fewer specialist appointments, longer waiting times, cuts to preventive care and early detection: Radiologist Dr. Chressen Regier warns of the consequences of the new GKV Savings Act — especially for statutory health insurance patients
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The GKV Contribution Rate Stabilization Act, known as the BStabG, was passed on July 10, 2026 under the leadership of the Federal Ministry of Health. According to the federal government, its aim is to curb expenditure growth in the healthcare system, stabilize supplementary contributions to statutory health insurance, and thereby provide financial relief for insured individuals.
At the same time, the reform is intended to secure "high-quality care for the coming years." For outpatient care, however, it will mean, among other things, the elimination of certain extra-budgetary reimbursements and a stricter cap on available funds starting in 2027.
While the federal government presents the law as a necessary step toward financial stability, doctors are warning of real consequences for outpatient care. In this interview, Dr. Chressen Regier discusses budgeting, declining reimbursements, and whether the financial relief promised to insured patients will ultimately come at the cost of reliable medical care.
Dr. Regier, you have been following the Contribution Rate Stabilization Act closely — not only from a professional standpoint, but also by taking a public position. What prompted you to speak out?
I see this system from two sides, and both have led me to this decision. One side isour large radiology group practice. There I see every day how many examinations in the statutory health insurance sector have long been running at a deficit — and that they are effectively viable only because of self-paying and privately insured patients. In Munich, this works because those patients exist here. In many other regions, it does not.
If the new law makes this situation worse, the consequences will fall directly on the care of statutory health insurance patients. If practices can no longer break even and cross-subsidization stops holding, these services simply cannot be offered to the same extent as before. The result will be a noticeable deterioration in care for statutory health insurance patients — and I find that deeply unjust.
The other side is that of the patient. Friends and acquaintances ask me to help them get appointments all the time. I'm happy to do it, and I do so without hesitation. But every time, the same thought crosses my mind: what about the people who don't know anyone? Anyone without connections in this system simply waits.
And if the appointment situation for statutory health insurance patients deteriorates further, that gap will only grow. The scarcer appointments become, the less access is determined by medical need — and the more it is determined by who can push hardest or who happens to know the right person.
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Dr. med. Chressen Regier, researcher and specialist in radiology
That is exactly the point at which this stops being a matter of professional policy for me. It becomes a question of the fundamental principle behind a solidarity-based system.
In the end, I decided to speak out for two reasons. First, because I was alarmed by how drastic the coming cuts for statutory health insurance patients will be. And second, because those cuts are not being communicated honestly. As a citizen, you get the impression that nothing much is changing apart from a few extra euros in pharmacy co-payments.
Budgeting is a complicated topic — it requires explanation — and that is precisely why so little is said about it. But when services that were deliberately protected up to now are placed under a budget — cancer screening, prenatal care, and parts of cancer treatment — this is no longer a matter of fees. At that point, the question becomes whether people receive timely treatment.
I believe it is our responsibility to say this out loud. We are the only ones who see what is actually happening inside practices. If we stay silent, no one will find out until it is too late.
Which regulations affect doctors in outpatient care most directly?
Three things, all working together.
First, the elimination of the TSVG reimbursement. Since 2019, appointments arranged through the 116117 hotline or referred urgently by a general practitioner, as well as open office hours outside the budget, were reimbursed outside the budget cap. This was the incentive that ensured urgent cases were prioritized — and it worked: in 2024, around 1.6 million appointments were arranged on time, the on-time rate was approximately 97 percent, and in radiology the average waiting time for these appointments was around seven days. The average across all appointments is 42 days. This reimbursement is now being eliminated. The referral pathways remain, but the effort will no longer be compensated.
Second, the massive expansion of budgeting. This is the point that really needs to be explained: until now, certain services were deliberately placed outside the budget. The GKV-Spitzenverband lists them on its own website — outpatient surgeries, early detection examinations, maternity care, vaccinations, radiation therapy services, and the care of cancer patients.
The rationale was that these services needed to be available in sufficient quantities — they were deliberately kept free from volume controls. Now, these are precisely the services being moved into the capped budget. This is not a minor technical adjustment; it is a reversal of the underlying logic.
Third — and this directly affects my own specialty — radiology is facing additional negotiations over a reduction to the Uniform Fee Schedule (EBM). The law instructs the Valuation Committee to review the technical service component in radiology, radiation therapy, and nuclear medicine by the end of March 2027. The legislative rationale references a reduction of 20 to 30 percent, effective from mid-2027, with total remuneration to be reduced accordingly. In other words, this is not a redistribution of funds — money is simply being taken out of the system.
For radiology, this means budgeting, the elimination of referral reimbursement, and the EBM reduction all hitting at once. According to KBV calculations, only 77 percent of the previous case volume would be funded going forward — the lowest figure of any specialist group.
Are there services and areas of care that will come under the greatest pressure?
The hardest hit will be the specialties whose day-to-day work consists precisely of the services now being placed under a budget. ENT medicine, because a large proportion of its appointments involve urgent cases — in that specialty, the average referral time through the appointment service center was just three days. The field delivered exactly what the TSVG was designed to achieve, and it will now bear the most severe consequences.
The Gynecology, because almost every appointment includes preventive care services and because new patients play a major role. The professional association of gynecologists estimates that up to 3.5 million short-notice gynecological care contacts per year across Germany could be affected, and has submitted a petition to the Bundestag accordingly.
Radiology, radiation therapy, and nuclear medicine, because these face the triple burden I just described.
And outpatient surgery. Here, budgeting is compounded by the elimination of extra-budgetary reimbursement — and this after years in which policymakers explicitly promoted the shift to outpatient care. Practices and centers responded to that signal: they restructured, built surgical capacity, hired staff, and made substantial investments. Those investments continue to generate costs, while the reimbursement basis that justified them is being pulled away.
Are there patient groups that are particularly vulnerable?
There are two levels here — one very concrete and one structural. Concretely, it is children and women who are most affected.
On children: pediatric and adolescent medicine had only recently been deliberately upgraded and exempted from the budget cap, because it has been chronically underfunded for years. That upgrade is now largely being reversed. A new regulation is being introduced that means that during cold and flu season — precisely when the largest numbers of sick children come in — the additional work will be reimbursed poorly or not at all.
At the same time, the well-child check-ups (U-examinations) are losing their protected reimbursement status — the very instrument used to detect developmental disorders early. The professional association of pediatricians puts it plainly: cutting spending on prevention in children risks higher costs and lower quality of life in later adolescence and adulthood. Also worth noting is how little input this specialty was given: professional societies were sometimes allowed fewer than four days to submit their statements.
On women: the services affected includegynecological cancer screening, prenatal care, necessary follow-up examinations, and timely investigation of abnormal findings. The president of the gynecologists' professional association (BVF) puts it bluntly: "Anyone who wants to politically strengthen prevention and early detection cannot simultaneously weaken its funding."
What particularly troubles me is the contradiction with the political announcements. Women's health was declared a priority issue in 2025, backed by a research program and a dialogue process. A year later, the same minister passes a law that disproportionately weakens women's healthcare.
And here lies what I see as the genuinely antisocial core of this. Policymakers have deliberately chosen budgeting over targeted service cuts. That is communicatively convenient, because it avoids having to name which service is being cut. Formally, everything remains a covered benefit — there is simply less of it available.
But as soon as something becomes scarce, it is no longer urgency that determines who gets it — it is the ability to push through. Those who call persistently get their appointment. Those who find the right words get it faster. Those who know someone get it straight away. And those who can pay privately get it regardless. Scarcity is never neutral. It distributes according to strength.
So those affected are not the people who already make heavy use of the system. Those affected are the reserved — people who don't want to be a burden — the elderly woman who won't call a second time, people with language barriers, families for whom every doctor's appointment is already an ordeal. In other words, exactly the people a solidarity-based system was created to protect.
This makes budgeting the least socially equitable form of cost-cutting one can choose. In the end, there will not be two tiers but three: privately insured patients, assertive statutory health insurance patients, and those who consistently end up getting the short end of the stick.
Where do you see the greatest gap between the political narrative and the real-world impact?
Reading the Federal Ministry of Health's press release, one gets the impression that for patients, nothing concrete will change beyond moderate co-payments.
What is not mentioned: that as budgeting expands, fewer and fewer appointments will be reimbursed — and therefore fewer will be offered. That this will lead to longer waiting times. That certain chronically under-reimbursed services will simply no longer be viable to provide. The association of specialist physicians (SpiFa) estimates that starting in 2027, at least 46 million specialist appointments will be lost with no replacement.
I also find the use of figures worth examining. The Federal Chancellor justifies the cuts by pointing out that medical budgets have increased by 40 percent over ten years. That figure is accurate. But it does not mean doctors are receiving more per service — it reflects the fact that more services were provided. More patients, more contacts. Doctors did not generate this demand. And what never appears in this calculation: according to SpiFa, around 43 million appointments per year in the specialist sector alone already take place today without any reimbursement whatsoever.
Then there is the announced appointment guarantee for specialist care. I consider that unrealistic. The reimbursement for fast appointments was just eliminated overnight — a regulation that had demonstrably worked. Under these conditions, practices cannot deliver on that promise. Guaranteeing access after removing its financial foundation is simply not honest toward patients.
The federal government insists that the quality of care will not suffer. How do you see it?
That's easy enough to test: what happens when medical services are no longer reimbursed beyond a certain volume?
Those services don't disappear from the catalog of covered benefits — they simply become scarce. On paper, everything is still available; there's just less of it. Medicine is not a volunteer activity. Services must be reimbursed. No practice can indefinitely provide care it isn't paid for.
The National Association of Statutory Health Insurance Physicians (KBV) now says this quite plainly itself: "A capped system cannot make unlimited service promises [, and w]hoever introduces budgets must also [...] say that [...] services are limited. Anything else is dishonest toward patients."
I have little to add to that. It's perfectly valid to say we need to cut costs — even to say exactly where. But you cannot cut 18 billion euros and simultaneously claim that nothing will change.
What advice do you have for colleagues who want to prepare?
I'm already seeing practices everywhere beginning to optimize for efficiency. Positions are being left unfilled, appointments are being scaled back, and office hours are being reduced.
In practical terms: run financial models. What ultimately remains will be significantly less than many people expect. The regional associations of statutory health insurance physicians (KVen) provide calculations to help assess individual situations and make timely adjustments.
Many colleagues are currently deciding to give up their panel doctor status or retire earlier than planned. From a business perspective, I find that entirely understandable and well-founded.
But I would hope for something different. What's happening right now is not collective protest — it's quiet withdrawal, practice by practice, each one on its own. That's understandable at the individual level, but cumulatively it's devastating, because the pressure doesn't disappear with those who leave. It gets distributed across fewer and fewer shoulders. And the fewer who remain, the greater the burden on each one of them.
That's why I would prefer a joint, visible protest. A quiet withdrawal produces no images, has no clear addressee, and can easily be explained away. In the end, people will simply say there aren't enough doctors. That's precisely why it matters so much that this issue is no longer kept out of the media.
How are you planning for the uncertainty around parts of the law that won't take effect until 2027?
Honestly — barely. A great deal hasn't been finalized yet, and we always feel the actual financial impact with a considerable delay anyway.
This is something outsiders often don't realize: a practice only finds out months after the end of a quarter what its work was actually worth, because the point value depends on how much all practices collectively have provided.
For the coming three quarters, we are essentially flying blind, not knowing which of the services we've provided will actually be reimbursed in the end. The KV offers model calculations that help to better assess the situation and make adjustments now. But ultimately, it's a blind flight until the first payment under the new law arrives.
The logical consequence is that everyone is now saving as much as possible so the surprise won't be too unpleasant. This, incidentally, is an unintended consequence of the reform itself: the uncertainty alone is already reducing supply before the law has even come into effect.
What are your short-term and long-term wishes?
In the short term, I would like Mr. Linnemann to take a step back and take the medical profession's warnings seriously. Pushing through changes of this magnitude in such a short timeframe, giving outpatient care no room to adjust, is a serious mistake. Changes will be necessary — no one disputes that. But losses of this scale require transitional periods to allow for an orderly reorganization.
In the long term, a concept is needed that organizes care more efficiently and, yes, deliberately cuts services that are not strictly necessary. Those do exist. But certainly not in prevention, cancer therapy, or emergency care.
This requires a shift in thinking, but above all open communication with those affected. The revenue side also needs to be addressed, as does the question of what the solidarity community should cover in the future — and what it should not. There are various concepts for this, and they deserve to be debated openly rather than obscured behind a budgeting system that no one has to explain.
Are there any initiatives, networks, or resources you would recommend?
For a solid overview, the KBV has published a position paper, "Securing Care Instead of Cutting It to Pieces," which summarizes the impacts concisely.
Organizations actively working on the issue include SpiFa, the voice of 160,000 specialist physicians; the Virchowbund, representing those in private practice; and Medi Geno Deutschland, which called for nationwide practice closures in June.
On the specialty level: the Professional Association of Gynecologists has submitted a petition to the Bundestag. The Professional Association of Pediatricians has provided a detailed analysis of the impact on pediatric medicine. The General Practitioners' Association has launched a campaign at hausarztpraxen-retten.de that also involves patients — an approach I think is particularly important.
And — this matters to me personally — talk to your patients about it. Not accusingly, but in an explanatory way. Most people have no idea that a significant portion of the appointments they receive are not reimbursed at all. Finding that out tends to considerably change their perspective.
