Private Health Insurers: Data and AI as Keys to Better Care

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The Association of Private Health Insurers (PKV) sees digitalization as a crucial lever for the future of medical care – both structurally and financially. In the course of the digital strategy presented by Federal Health Minister Nina Warken, the PKV association is now demanding speed, stability, and open competition in its implementation.

"For the success of digitalization, it is crucial that it is implemented openly, competitively, and with a focus on the patient. Digital appointment offers must be available to all patients," said Florian Reuther, Director of the PKV Association.

Open Systems and Stable Infrastructure

From the PKV's perspective, digitalization must not occur in isolated, closed-off solutions. Digital appointment platforms, telemedicine services, and data interfaces must be designed to be interoperable and open to all insured individuals – regardless of their insurance system.

A reliable technical foundation is also central. However, access to the telematics infrastructure must be simple and practical for insured individuals and service providers. The prerequisite for acceptance and trust is stable operation with few disruptions. System failures with e-prescriptions and technical disruptions in the telematics infrastructure have shown that complexity needs to be reduced and responsibilities clarified.

"We see great opportunities in data-driven applications that not only serve research but are also used directly in care. For this, legally sound framework conditions are now needed," said Reuther. Private health insurers can offer an electronic patient record (ePA), but they are not obliged to. Furthermore, there is no legal basis for private health insurers to transmit the data of privately insured individuals to the Forschungsdatenzentrum Gesundheit (Health Research Data Center).

Digital Initial Assessment and More

Digital applications must also specifically contribute to relieving the burden on practices – for example, through digital initial assessments, better appointment scheduling, or automated documentation. Data protection must not act as a brake on innovation but must be implemented through practical data security.

In the context of the digitalization debate, the PKV also points to fundamental financing issues, likely due to the demands for a "Bürgerversicherung" (citizen insurance), which is heavily criticized by the PKVs. At the "Southwest Doctors' Summit 2026: Future of Medical Care & the Medical Profession“, Reuther pointed to around 340 billion euros in provisions that have been accumulated in the funded system. These reserves arise because privately insured individuals pay higher premiums when they are younger than the benefits they receive. The funds are invested to finance rising healthcare costs in old age. At the same time, the association emphasizes the role of privately insured individuals for outpatient care. "Without attractive physician remuneration, we will of course not attract any doctors, and then we will not be able to provide any care either," said Reuther.

Telemedicine in Rural Areas

The situation in rural areas is also difficult. There, digitalization is a hope, as Bad Wurzach's mayor Alexandra Scherer made clear. Many older citizens are less mobile, and in some places, there is a lack of adequate broadband supply, meaning digital services like telemedicine cannot be used as a matter of course. Given demographic change, there is a need for solutions that function technically and also consider the specific conditions in rural areas.

ePA Remains a Point of Contention

While politicians and health insurers are pushing for stable systems, the electronic patient record (ePA) continues to fall short of expectations in practice. A current survey by the interdisciplinary medical association MEDI GENO Deutschland e. V. among 263 general practitioners and psychotherapists shows clear reservations: around 65 percent rate the ePA as "not secure" or "not at all secure" regarding data protection. Approximately 72 percent view the safeguarding of medical confidentiality as "critical" or "very critical." 84 percent see no relief in daily practice.

Dr. Christian Messer, deputy chairman of MEDI GENO Deutschland e. V., said: "For a year and a half, we have been intensively pointing out the lack of data protection and the liability issues in case of breaches of medical confidentiality due to the non-transparent access. Many of our members are now being released from their liability by their patients."

Similarly, the organizational effort for doctors in hospitals and practices is viewed critically. "Currently, the electronic patient record offers no added value for either the treating physicians or the patients. It cannot be that we have to work with a completely immature system in full practice operation," says Dr. Bernhard Schuknecht, deputy chairman of MEDI Baden-Württemberg.

(mack)