The interview partners
Prof. Dr. Patrick Da-Cruz is a professor of business administration and health management in the School of Health Management at Neu-Ulm University of Applied Sciences (HNU) and the academic director of the MBA program in Leadership and Management in Healthcare.
Prior to joining HNU, Mr. Da-Cruz worked at renowned strategy consulting firms in the pharmaceutical and healthcare sectors and held leadership positions at companies in the healthcare industry both in Germany and abroad.
Prof. Dr. Uta M. Feser studied business and social pedagogy and earned her doctorate at the Chair of General Banking, Insurance, and Banking Management at Friedrich-Alexander University Erlangen-Nuremberg. Throughout her professional career, she has held various leadership positions in companies specializing in hospital management and consulting. Feser's tenure at HNU began in 2000: first as a professor of health management, and then, starting in 2006, as president of the university. From 2012 to 2020, Feser served on the board of Hochschule Bayern e.V., including four years as chairwoman. From 2006 to 2017, she served as chair or vice-chair of the Conciliation Committee under Section 17c of the Higher Education Act (KHG) in Baden-Württemberg; in 2024, she served as chair of the BayWISS Steering Committee; and from 2024 to early 2026, she served as spokesperson for the HRK Working Group on Health Sciences. Since May 2022, she has served as the representative of the universities on the Bavarian Media Council. After four terms as president of the HNU, Prof. Dr. Uta M. Feser retired in 2026.
Roger Jaeckel is an honorary professor in the School of Health Management and has held leadership positions in the healthcare industry since 2004, focusing on health policy, market strategy, and patient access. In addition, he is the chair of the advisory board for the HNU’s MBA program in Leadership and Management in Healthcare. He is the author of numerous publications on topics related to health policy and healthcare, including co-editor of two reference books, “Market Access in Healthcare”. . Since 2023, Roger Jaeckel has been working as a senior consultant at the Ulm-based consulting firm bcmed. Since 2024, he has been Head of Governmental Affairs and Health Care Management at Paul Hartmann AG, Germany, in Heidenheim.
With the Statutory Health Insurance Premium Rate Stabilization Act, health policymakers are making a new attempt to establish stable framework conditions in the healthcare system. How promising do you think this reform approach is?
Prof. Roger Jaeckel: The reform proposals were drafted by the Health Finance Commission and were already part of the current coalition agreement.
According to the Commission's report, this ultimately resulted in 66 individual proposals, which health policy makers narrowed down to 50 measures in the current draft bill—measures intended to have a positive impact on future spending and revenue trends.
Prof. Dr. Uta M. Feser: The Statutory Health Insurance Premium Stabilization Act and the resulting efforts to stabilize premiums are, at their core, a massive balancing act. They are trying to patch up a system that is under structural pressure.
What stands out in particular here?
Prof. Roger Jaeckel:The focus here is clearly on the expenditure side, through measures to restrict service providers and higher co-payment arrangements for those with statutory health insurance. The budgetary principle of ‘revenue-oriented expenditure policy’, which has been in force in the statutory health insurance system for decades but had seemingly fallen by the wayside, has been dusted off and brought back into use. The main reason for this is the state’s refusal to meet its wide-ranging payment obligations. The financial difficulties facing the statutory health insurance system (GKV) are therefore also the result of government failure, the burden of which must be borne by the other stakeholders.
Prof. Uta Feser: The demographic check is the elephant in the room here: the number of contributors is falling, whilst the number of benefit recipients (as baby boomers retire) is rising. A stabilisation act alone cannot solve the mathematical problem; at best, it can provide a political stopgap for one or two years.
What, in particular, do you feel is missing from the forthcoming reform?
Prof. Dr Uta M. Feser: A sustainable structural reform to ensure intergenerational fairness. If we accept that healthcare is a generational contract, its management must not remain trapped within the 4-year political election cycle. A generation spans 30 years; during that time, there may well be 7.5 different health ministers, each with their own coalition or party policies.
Prof. Roger Jaeckel: Aspects of demographic change play a central role in any healthcare system. This has implications for future care needs, which clearly do not feature in the current debate on reform. If demographic change continues to be ignored in future, the healthcare system faces the threat of rationing on an unprecedented scale. It is therefore the state’s particular responsibility to ensure that a healthcare system based on solidarity is fit for the future. This financial reform reduces the proposed measures to a very short-term perspective, with no real long-term impact. Political statements to the contrary are mere rhetoric, particularly as the quality of medical and nursing care has not been given any significant consideration.
What reform proposals would you put forward for health policy?
Prof. Roger Jaeckel: It is becoming apparent that regulatory interventions aimed at further developing a healthcare system are reaching their limits. The demands placed on policymakers have become too complex for this. The example of hospital reform illustrates that large-scale reform measures cannot be implemented in a reasonable manner, either in terms of time or content. The result is pages upon pages of legal text, which leads to excessive bureaucracy and ultimately amounts to a departure from principles relevant to healthcare provision, because the healthcare system is no longer comprehensible. Patient-centred care has long since ceased to be the benchmark for political action. The attempt to organise healthcare provision through legal provisions has reached a critical juncture that must be critically scrutinised.
Prof. Dr. Uta M. Feser: I would like to pick up directly where my colleague Roger Jaeckel left off: we need to establish a new form of governance in the healthcare sector that promotes intergenerational equity in healthcare, independent of politics. This would shift the focus away from ‘vote-winning’ and towards the quality of care.
What might this look like? A panel of experts would set contribution rates and the catalogue of benefits, without the Health Minister having a direct right of veto. In much the same way as the Bundesbank combats inflation, this institution would oversee the contributions. It could build up reserves (a generational fund) which the Chancellor of the Exchequer would not be permitted to draw upon. This would smooth out contributions over decades. Fewer decisions based on lobbying.Services are only included in the catalogue if their effectiveness has been proven.
A less erratic approach to policy would also lead to greater planning certainty for those involved in the healthcare sector and for contributors.
What recommendations and advice would you offer regarding forthcoming healthcare reforms?
Prof. Roger Jaeckel: Healthcare cannot be managed through political deals. It requires politically neutral bodies that are characterised above all by expertise and continuity, rather than constantly reinventing themselves in line with coalition agreements. Demographic change requires long-term measures that can no longer be dictated by four-year political terms of office.
Prof. Dr Uta M. Feser: Establishment of an independent body: the creation of a committee for intergenerational equity in healthcare. This body should be granted autonomy that extends beyond four-year electoral cycles, for example through 12-year terms of office for its members.
Financial firewall: Legal safeguards to ensure that statutory health insurance (GKV) contributions are held as a special-purpose fund. The state must no longer be permitted to finance non-insurance-related services from contributions without triggering an automatic tax subsidy.
Investment commitment: Binding commitments to hospital modernisation projects over a 20-year period, to provide planning certainty for the transformation of the hospital sector. This is complemented by structural and operational measures.
What will become of the Statutory Health Insurance Contribution Rate Stabilisation Act?
Prof. Roger Jaeckel: Unless there are any discernible changes to the political response patterns seen so far, we will be dealing with a law aimed purely at containing costs, without any innovative management approaches. This observation is further compounded by the fact that the federal budget is to be consolidated at the expense of the statutory health insurance scheme (GKV) and those with statutory health insurance. This represents a new development in German health policy, which will lead to widespread dissatisfaction amongst the public, as state-funded subsidies are borne by all sections of the population, whether they have private or statutory health insurance. This line of thinking no longer seems to feature in political discourse.
Prof. Dr Uta M. Feser: The Contribution Stabilisation Act will, in the short term, help to limit the damage in the healthcare sector, but this is likely to leave all those involved dissatisfied. In the short term, the Act will cap the most severe deficits, but in the long term, like all previous legislation, it will reach its limits. It will cushion the sharp rises in contributions for one or two years, but it will not address the underlying causes. As it does not build up reserves for the future but merely manages the current year’s deficit, it has the opposite effect to sustainability, because it stabilises contribution rates at the expense of those who will have to pay higher contributions in 10 to 20 years’ time. The law will ‘turn out well’ for the politicians of the current parliamentary term, as it prevents a collapse. However, it will turn out badly for intergenerational fairness, as it merely pushes the real problems further into the future.
Thank you very much for the interview!
The content and statements presented in the interviews reflect the perspectives of the interviewees and do not necessarily represent the editorial staff's position.
