Big Coalition in Germany

by Jonas Wolframm
What's in it regarding healthcare?

New coalition treaty – what's in it regarding healthcare?

Originally, the Christian Democrats (CDU/CSU) and the Social Democrats (SPD) had planned to end coalition talks on Sunday. However, as there are still several contentious issues to be negotiated, both parties have agreed to extend the talks until Tuesday night. Per an internal document obtained by RPP, the coalition treaty is now likely to be signed on Wednesday morning, provided both parties can agree on a lowest common denominator.

From a topical point of view, most critical issues have – according to the latest version of the draft – been resolved by the negotiation teams. Amongst them the restoration of parity regarding health insurance premiums. However, some aspects of healthcare and labour policy are still contested, and the outcome is relatively open.

Healthcare – which policy proposals are in the draft?


Both parties have vowed to implement immediate measures to increase salaries of caregivers and to curb overtime hours. Against the backdrop of major staff shortages, a hiring program will be introduced to recruit 8000 caregivers as soon as possible. Moreover, care institutions must comply with new and higher minimum staff regulations to reduce the workload of single caregivers. To make the care profession more attractive, CDU/CSU and SPD also want to increase the number of tariff-bound jobs in the industry. The current draft of the coalition treaty would also ease existing burdens for caring relatives, as it foresees an expansion short-term care offering.

Cross-sectoral healthcare provision

In cross-sectoral healthcare provision, both parties want to enable better cooperation between the stationary and outpatient sector. A workgroup consisting of the Federal Ministry of Health, state governments and parliamentary groups of the Bundestag will be established to work out a strategy until 2020.

Ambulant healthcare provision

The most urgent issue in ambulant care is currently the shortage of physicians in rural areas. To solve this problem, the CDU/CSU and SPD are planning to reform requirement planning. On top, approval quota for physicians in areas with staff shortages are going to be abolished.

The innovation funds of the Joint-Federal Committee (G-BA) to promote innovative model-projects will be continued with a budget of 200 million Euro over the year 2019. Both parties see the fight against widespread diseases such as cancer, dementia and psychological disorders as a focal point for the current legislative period. The implementation of a national diabetes strategy and disease-management-programmes for back spasms and depression are examples of already planned projects.

Aside from nationwide sufficient healthcare provision by physicians, CDU/CSU and SPD also want to secure provision of services which are provided by pharmacists and midwives. In palliative care, both negotiation teams have agreed to improve the provision of palliative services for children and elderly.


The ongoing quality campaign will be continued. In this context, the two objectives improving quality-oriented division of work and improving the connection of hospitals for basic healthcare provision with specialized centres are explicitly mentioned. Speaking of specialised centres for complex or rare diseases, the negotiators have agreed to further support the establishment and financing of specialised multidisciplinary centres for rare or complex diseases. A reform of the hospital planning procedure will reflect the importance of such centres. The current case-based DRG-system will be remodelled. Costs for care services will be reimbursed differently to eliminate misplaced economic incentives.

In order to increase the number of organ donations, hospitals will be required to install a commissioner for transplantations. Moreover, fees for transplantations will be increased. To prevent the outbreak of hospital-acquired infections, both parties have agreed to continue the ongoing hygiene program for hospitals.

Healthcare professions

Regarding reforms in the area of healthcare professions, both parties have agreed to abolish tuition fees for non-medical healthcare professions. Moreover, the number of study places for physicians will be increased. To meet future challenges within healthcare, a possible new government could also reconsider the current distribution of tasks between physicians and other non-physician professions. Here, the direction seems clear: the latter are likely to gain more competencies.


The law on prevention will be reformed and a national health portal will be established. Additionally, the possible new government will explicitly focus on the prevention of chronical diseases stemming from overweight. In this regard, reducing the number of overweight children and young adults will be a central point on the healthcare agenda for the upcoming four years. Furthermore, both parties have agreed to increase support for research in the field of youth medicine.

Differences to be solved

During the negotiations, healthcare has proven to be a real apple of discord. In detail, both negotiation parties are disputing over the Rx-mailorder-ban for prescription drugs, the financing of the structural funds for hospitals, and the financing of the statutory health insurance (GKV).

Especially, the ban on Rx-mailorder services has been controversially discussed by both parties, with the CDU/CSU backing a full ban, arguing that mail-order services threaten local pharmacies. On the contrary, the SPD views Rx-mailorder-services as a tool to guarantee provision of medicinal products even in rural areas. To support small local pharmacies, the SPD plans to reform the scale of fees for pharmacists.

Another point of disagreement between the two is the financing of the GKV – in particular, CDU/CSU and SPD are fighting over the height of insurance premiums. Here, the Social Democrats aim at abolishing additional premiums, whereas the Christian Democrats want to keep them but restore parity between employers and employees’ contributions. Furthermore, opinions are mixed on lowering insurance premiums for entrepreneurs and artists.

What happens next?

The remaining controversial points are now discussed by the leading figures of both parties since the workgroups have finished their job. It is not probable that healthcare will be a stumbling block for another “grand” coalition. However, it will be interesting to see which party is ready to give more concessions.

When looking at the whole picture, it seems possible that the SPD could make concessions in healthcare in a trade for agreements in other controversial policy fields such as labour. For example, both parties cannot agree on the abolition of unfounded fixed-term contracts. The abolition has been a landmark policy objective for the SPD throughout the whole 2017 election campaign. If the SPD prevails in this question, the leadership would have an additional argument at hand to persuade the skeptical party base to vote for the “grand” coalition in a membership vote on the issue later this month. From this perspective, a trade-off would make a lot of sense for both party leaders.


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