As of April 1st, remuneration for psychotherapeutic services will be reduced by 4.5 percent. While health insurance funds characterize this as an “appropriate compromise,” psychotherapists fear a further worsening of care access.
Dispute Over Honorariums
The dispute began in February when a proposal from the GKV-Spitzenverband—the umbrella organization of statutory health insurance funds—to cut honorariums by ten percent was leaked, according to the Deutsches Ärzteblatt. A joint committee of health insurance funds and the Kassenärztliche Bundesvereinigung (KBV, the National Association of Statutory Health Insurance Physicians) reviews and decides on honorariums annually. Andreas Gassen, chairman of the KBV, strongly opposed the proposed cuts, calling them a recurring “method” of the GKV and an “impropriety.”
After failing to reach an agreement, the committee was expanded to include three impartial members. Despite this addition, the KBV was unable to prevent the honorarium reductions, which will now seize effect on April 1st at a rate of 4.5 percent, rather than the initially proposed ten percent.
The GKV-Spitzenverband released a statement describing the outcome as an “appropriate compromise” that considers the interests of both psychotherapists and those who pay into the health insurance system.
Rising Demand, Limited Access
Psychotherapists have expressed dissatisfaction with the cuts, and a petition against the initial ten percent reduction garnered over 300,000 signatures within days, initiated by psychotherapist Johanna Alisa Jung. A strong outpatient psychotherapeutic service is “crucial for the stability of our healthcare system and our society,” Jung wrote, calling the decision “incomprehensible” and a “contradictory signal.”
The necessitate for psychotherapy is increasing, as evidenced by statistics from Statista showing that mental illnesses were among the top three reasons for sick leave in 2024. The DAK health insurance fund reported a 50 percent increase in sick days due to depression in 2024 compared to the previous year. Legally insured patients often face months-long waits for an available appointment.
Limited access is partly due to a shortage of available Kassensitze—licenses to bill statutory health insurance funds. Often, therapists must take over a license from a departing colleague, and the acquisition of a Kassensitz is frequently tied to the purchase of the practice itself. According to a report by Plusminus, Kassensitze can cost over 100,000 Euro for a half-share.
Financial Pressures and Potential Consequences
The GKV-Spitzenverband points out that the number of Kassenzulassungen (licenses to bill statutory health insurance) increased by around 63 percent between 2013 and 2025, but argues that this has not translated into improved care or shorter wait times. They suggest the issue lies in the amount of time psychotherapists spend with GKV-insured patients compared to other specialist groups.
The financial realities facing psychotherapists are significant. After completing their psychology studies, graduates often finance their training—which can cost tens of thousands of Euro—out of pocket. Securing a practice with a Kassensitz often requires taking out a loan, as evidenced by psychotherapist Andy Sharif, who reportedly took out a 50,000 Euro loan to finance his half-share.
Sharif and others fear that the honorarium cuts will ultimately impact legally insured patients, as therapists may be forced to allocate more slots to private patients and self-payers to maintain profitability, further extending wait times.
Frequently Asked Questions
What is the GKV-Spitzenverband?
The GKV-Spitzenverband is the umbrella organization of statutory health insurance funds in Germany.
What is a Kassensitz?
A Kassensitz is a license that allows a therapist to bill statutory health insurance funds for their services.
How much did honorariums for psychotherapists increase between 2013 and 2023?
According to the GKV-Spitzenverband, average honorariums for psychotherapists increased by 52 percent between 2013 and 2023, while honorariums for other medical specialists increased by 33 percent.
Given these developments, how might the changing financial landscape of psychotherapy impact access to care for those with statutory health insurance?
