Representatives of HIV physicians expressed, in a press release, alarm and bewilderment at the government’s health reform plans. Only a few weeks after the Health Financing Commission’s report was presented, the Ministry of Health last week put forward, as a step, a draft bill titled the “Law to Stabilize Contribution Rates in the Statutory Health Insurance.”
This draft bill is a “radical and dangerous cap on essential services in the name of alleged contribution stability,” criticized the German Association of Outpatient Physicians for Infectious Diseases and HIV Medicine (dagnä), the German Society for Infectiology (DGI), and the German AIDS Society (DAIG). In just a few years, outpatient HIV care in Germany could collapse.
“A law that effectively limits the available scope of services—even in HIV care—ignores the epidemiological reality,” said dagnä board member Michael Sabranski. Since 2014, the number of cases in specialized HIV care has risen by about 40 percent and is expected to rise further.
The rise is driven not only by annual new infections but also “the medical success of specialized HIV therapy.” This progress means that people living with HIV today can reach an age similar to the general population. But with aging comes more coexisting conditions, so the need for complex medical and psychosocial support in HIV-focused practices will continue to grow.
Potential cuts to services
“When case numbers rise and the budget is capped, massive cuts in care per patient are effectively the consequence,” commented Sabranski. The quality of care would fall immediately—in the worst case, it is imaginable that HIV-focused clinics would have to turn away new patients because there is no longer funding for the necessary capacity. “This is nothing less than an attack on patient safety,” said Sabranski.
The intensive care of patients by a nationwide network of HIV-focused clinics is regarded internationally as a success model and a cornerstone of the quality of care in Germany, yet the proposed law would strip away the financial foundation for this complex care. “If extrabudgetary services are reduced or capped, there will be cuts to existing structures and the loss of urgently needed new care models,” the doctors warned. “Also the prevention successes of recent years, such as HIV pre-exposure prophylaxis (PrEP), which is also an extrabudgetary service, will be jeopardized; a possible uptick in new infections will be accepted.”
Arbitrary budget caps and potential staffing shortages
From the perspective of dagnä, DGI, and DAIG, a health policy contradiction becomes visible: “While Germany officially aims to end AIDS by 2030, outpatient therapy is being hollowed out—the most important pillar of care. It is clear: only a stable, nationwide, high-quality treatment can ensure patient safety—and prevent new infections,” the associations said in their press release.
The cuts could also have indirect effects: “Which young doctor would choose HIV specialization under these conditions?” asked Markus Bickel, a dagnä board member. If “economic predictability is replaced by arbitrary budget caps,” there will be no incentive for new talent. “We are steering, with our eyes wide open, into a shortage of skilled professionals, and in the end the patients will suffer.”
The associations therefore urge policymakers to permanently secure HIV care as an extracurricular, extrabudgetary individual service and to exempt it from the proposed overall remuneration under Section 87d(1) of the bill. It is essential to ensure that medical innovation and demographic change are reflected in the service structure.
