Can de-budgeting save primary care in Germany? A turning point for general practice

Abstract

In its last healthcare act, Germany's previous government abolished budget caps for general practitioners (GPs) in February 2025, exempting most primary care services from quantity limits and fee reductions. Originally introduced in 1993 to control healthcare costs, budgets have led to significant financial shortfalls for outpatient practices. Meanwhile, a worsening GP shortage - driven by high retirement rates, changing career preferences, and increasing healthcare demand - has made primary care reform urgent. The new law seeks to make general practice more attractive but does not cover all GP services. Critics warn of financial burdens, with health insurers estimating additional annual costs of €400 million for GPs. While de-budgeting is a key step, broader reforms - strengthening practice structures, medical education, and digital systems - are needed to secure the future of primary care.