The proposal, buried in technical negotiations, would cut what psychotherapists earn per session, even as demand for treatment keeps surging across the country.
Insurers press for a 10% cut in psychotherapy fees
Germany’s statutory health insurance funds (known as Krankenkassen) want to reduce remuneration for all psychotherapy services by a flat 10 percent this year. The plan has been put on the table by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), the main body representing Germany’s public insurers.
The move is expected to be discussed at the next meeting of the federal Valuation Committee (Bewertungsausschuss, BA) in March. This powerful but low‑profile body sets the financial value of medical services in Germany’s outpatient sector.
The proposal would trim earnings for every insured psychotherapy session, from first consultation to long-term treatment, across the board.
The official BA decision from a January meeting refers only to a “review” of the current valuations. Behind closed doors, insurer representatives are reportedly pushing this review towards a clear target: a 10 percent downgrade of fees for psychotherapists.
Insurers stay silent, citing confidential talks
Asked to clarify their position, the GKV-Spitzenverband neither confirmed nor denied the cut. Instead, the group stressed that they aim to find “joint solutions” within Germany’s self-governed health system.
They also insisted that negotiations with doctors’ associations must remain confidential until a final decision is reached in the Valuation Committee. For now, that leaves doctors, therapists and patients guessing what exactly is being prepared in the background.
Doctors’ leaders accuse insurers of a ‘lawnmower’ approach
The head of the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV), Andreas Gassen, has sharply condemned the idea. He describes the proposed 10 percent cut as a “lawnmower method” – a term used in Germany for across‑the‑board reductions that ignore individual needs and realities.
Gassen argues that public insurers have turned blanket cuts into a routine tool, affecting GPs, specialists and now psychotherapists alike.
He accuses insurance officials of ignoring the everyday reality of their own insured population. Demand for psychotherapy has risen significantly in recent years, driven by stress, depression, anxiety and the psychological fallout of the pandemic and economic insecurity.
Gassen poses a blunt question to the insurers: if they insist on such severe cuts, which services should then simply no longer be provided? In his view, it is dishonest to demand lower prices and still claim that the same level of care can be maintained.
Psychotherapists sound the alarm
Psychotherapists themselves view the proposal as a direct threat to care for people with mental illness. Dieter Adler, who chairs the German Psychotherapists’ Network (Deutsches Psychotherapeuten Netzwerk, DPNW), calls it a deliberate political decision disguised as a technical adjustment.
Adler describes the move as a “planned savings decision on the backs of people with mental illness,” rather than a neutral recalculation.
He warns that the demand for psychotherapy is climbing, not falling, while insurers try to reduce what they pay for each session. From his perspective, sending a signal that therapy is worth less money, just as more patients seek help, shows a worrying disconnect from clinical reality.
Adler also highlights a potential consequence that could quickly become visible to patients: many therapists might shift their time and energy to privately insured patients, who bring in more stable and often higher income. If statutory insurance fees drop by 10 percent, some therapists could decide they simply cannot sustain the same number of publicly insured patients.
Inflation adds another layer of pressure
The timing of the proposed cut frustrates many practitioners. Between 2022 and 2024, cumulative inflation in Germany is estimated to have reached around 16 percent. Rising costs for rent, energy, practice staff and professional insurance have already eroded psychotherapists’ purchasing power.
From the DPNW’s point of view, a realistic adjustment would have moved fees up by roughly 16 percent since 2021, just to keep practices economically stable. Instead, psychotherapists are now facing the opposite scenario: a 10 percent reduction on top of the inflation hit.
Taken together, inflation and the proposed cut would push many practices far below the income level needed to maintain current services.
For small practices with one or two therapists, profit margins are often narrow. A double squeeze of higher costs and lower income can translate into fewer therapy hours, longer waiting lists, or even closures, especially in rural areas where coverage is already thin.
What this means for patients in real life
Longer waiting times and fewer therapy options
If fees drop, many therapists are likely to re‑evaluate how they allocate their limited appointment slots. Some possible scenarios for patients include:
- Longer waiting times for first appointments with publicly funded therapists
- More practices limiting the number of statutory-insured patients they accept
- Growing regional gaps, with rural and low-income areas hit hardest
- More patients turning to out-of-pocket private therapy, if they can afford it
For someone with severe depression or anxiety, waiting months instead of weeks for a therapy slot can mean more sick leave, higher risk of crisis, and heavier reliance on medication or emergency services.
Why fee cuts matter in a fee‑for‑service system
Outpatient psychotherapists in Germany are usually paid per session under a complex points-based system known as the EBM (Uniform Value Scale). The Valuation Committee translates these points into euros. When the committee reduces the value of those points, each therapy session brings in less income.
| Factor | Trend 2021–2024 | Effect on therapists |
|---|---|---|
| Demand for psychotherapy | Rising | More patients seeking help, fuller appointment books |
| Inflation | Approx. +16% | Higher practice costs, shrinking real income |
| Proposed fee change | -10% | Lower pay per session, extra financial pressure |
In such a system, even modest reductions can change how attractive the statutory insurance sector looks compared with private pay or alternative professional paths such as coaching, online consulting, or partial employment in clinics.
Key terms patients keep hearing
For many people outside Germany’s health policy bubble, this debate can sound highly technical. Three concepts help clarify what is at stake:
- GKV (statutory health insurance): Public insurers that cover around 90 percent of residents. They negotiate with doctors and therapists on what is paid for and how much.
- Valuation Committee (Bewertungsausschuss): A joint body of insurers and physicians’ associations that sets the billable value of outpatient medical services in the statutory system.
- Psychotherapy session: Typically 50 minutes of structured treatment with a licensed psychotherapist, often provided weekly over several months.
When fees change at the top level, those decisions eventually filter down into how many sessions a therapist can realistically offer under statutory insurance without risking financial strain.
What patients and families can do now
While the negotiations continue behind closed doors, patients worried about access to therapy can take some pragmatic steps. Anyone already in treatment with a statutory-insured therapist should keep scheduled appointments and discuss any concerns openly. Therapists can explain whether the proposed changes might affect availability in their practice.
People currently on waiting lists might consider parallel options: regional crisis services, short-term counselling, or group therapy, which can sometimes be easier to access. Self‑help groups and digital mental health programmes funded by insurers can also provide support while waiting for full psychotherapy. None of these replace regular one‑to‑one therapy, but they can reduce the risk of a complete care gap if the political battle over fees drags on.
