The statutory health insurance (GKV) in Germany finances services from the special therapeutic directions that are medically not or only insufficiently evidence-based. These include homeopathic treatments and medicines, anthroposophical approaches and phytotherapeutic preparations. These directions are recognised in the Medicines Act as special therapeutic directions and are subject to lower requirements for proof of efficacy than conventional medicines. The Federal Joint Committee does not examine them within the same strict framework as standard benefits. Instead, the health insurance companies can reimburse them voluntarily as statutory benefits, via selective contracts or in optional tariffs and bonus programs. The scientific consensus does not see any effect with these methods beyond the placebo effect or only traditionally justified effects without sufficient modern randomized controlled trials for broad applications. Nevertheless, numerous health insurance companies use these offers to differentiate themselves in the competition for insured persons and to meet demand.

The legal basis for these reimbursements lies in the Social Security Code V and the Medicines Act. Since the 2007 health reform and the 2012 Statutory Health Insurance Structure Act, health insurance companies have been allowed to cover non-prescription medicines of special therapies as statutory benefits up to certain amounts. For children up to the age of twelve and adolescents with developmental disorders up to the age of eighteen, there is a legal obligation to reimburse homeopathic remedies as a standard benefit. In addition, the health insurance companies design voluntary services. In 2023, the total expenditure of the statutory health insurance amounted to 306.24 billion euros. For 2024, they were 326.85 billion euros. Within this total, expenditure on medicines accounts for a total of about 14.3 to 16.8 percent, with special therapeutic directions accounting for only a negligible share.

Homeopathy is based on the principle of similarity and strong dilutions. It is used for a variety of ailments, from mild colds to chronic illnesses. Anthroposophic medicine integrates spiritual and holistic elements and, in addition to medicines, also includes therapies such as eurythmy therapy or artistic therapies. Phytotherapy uses herbal active ingredients and is partly traditionally justified, but not backed up by high-quality evidence for all indications. All three directions fall under the special therapeutic directions and are often reimbursed bundled in budgets. The evidence shows that randomized trials do not demonstrate consistent advantages over placebo or standard therapies. Nevertheless, health insurance companies reimburse these services because they are considered patient-friendly and relevant to competition.

Concrete examples from practice illustrate the implementation. A total of about 70 health insurance companies offer reimbursements for homeopathy, of which around two-thirds of the insurance companies offer some form of reimbursement. For phytotherapy, the figures are around 69 health insurance companies, often together with the other directions. The AOK shows strong regional differences. Within a 500-euro health budget, AOK NordWest reimburses 80 percent of the costs for pharmacy-only, non-prescription medicines in homeopathy, anthroposophy and phytotherapy, up to a maximum of 500 euros per calendar year. The AOK Baden-Württemberg grants up to 300 euros per year for alternative medicines, including phytotherapeutic preparations, if prescribed by a doctor with additional qualifications. AOK Hessen reimburses up to 150 euros per year for homeopathic medicines. The AOK Rhineland-Palatinate/Saarland limits the reimbursement to 75 euros for homeopathic medicines, 25 euros for anthroposophical and 25 euros for phytotherapeutic remedies, as well as up to 75 euros for homeopathic treatments. Other AOK regions vary between 25 and 300 euros. These variations result from autonomous statutory decisions of the regional AOKs and lead to inequalities depending on the place of residence.

Other large health insurance companies follow similar patterns. The Techniker Krankenkasse (TK) has concluded selective contracts and reimburses homeopathic treatments with qualified doctors. Medicines in special therapeutic directions are included in global budgets. Barmer offers contracts with reimbursement for medicines in certain groups. Many health insurance companies bundle the services in global budgets of 50 to 500 euros, which cover homeopathy, phytotherapy and anthroposophy together. At the BERGISCHE Krankenkasse, for example, there are limited amounts for the special therapeutic directions. Overall, almost all statutory health insurance companies reimburse at least one of the directions in one model, with the focus on homeopathic and phytotherapeutic medicines.

The total burden on the health system from these services can be quantified using precise figures. In 2021, the GKV’s expenditure on homeopathic and anthroposophic medicines was around 22 million euros. Expenditure on homeopathic services fell from 46.4 million euros in 2017 to 8.7 million euros in 2023. Phytotherapeutic remedies are partly included in these sums, as they are often billed together, and increase the amount only marginally. Estimates for the direct expenditure of the GKV for homeopathy and anthroposophy are currently 20 to 22 million euros per year, in some figures around 25 million euros. With total statutory health insurance expenditure of 326.85 billion euros in 2024, the share for homeopathy and anthroposophy corresponds to less than 0.05 percent, more precisely less than 0.007 percent. On average, the burden per insured person is less than 0.30 euros per year, based on around 73 million GKV insured persons and 22 million euros in expenses. Individual health insurance companies report average expenditure of up to 11.29 euros per capita in some regions, with a user rate usually below 1.4 percent of the insured.

Calculations of the costs per cash register show low individual amounts. At TK, with over 11 million insured persons, expenditure on homeopathy is in the low single-digit million range per year, which accounts for less than one per thousand of total expenditure. Barmer, which has around 8.6 million insured persons, reimburses comparable amounts. AOK Rheinland-Pfalz/Saarland spent around 13,000 euros on homeopathy in 2023. According to estimates, a complete cancellation of all voluntary services from the special therapeutic directions – including homeopathy, anthroposophy and phytotherapy – would save a maximum of 20 to 50 million euros, with the direct share for these three directions being 20 to 25 million euros. Compared to other areas of expenditure such as hospital treatment with over 100 billion euros or outpatient medical treatment with around 50 billion euros, these sums seem marginal. Nevertheless, they add up with tight health insurance budgets and contribute to deficit discussions.

The cost development over the years shows a significant decline. From 46.4 million euros in 2017 to 8.7 million euros in 2023, homeopathy expenditure fell due to lower take-up or stricter budgets. Nevertheless, the services remain relevant to competition. Costs of up to 153 euros per user are incurred on average in active programs, which results in the total sums mentioned with an assumed user rate of one percent of the insured. A detailed projection for 2023: With 8.7 million euros in direct expenditure and an average useful life of one to two years per insured person, this results in annual additional expenditure per active user of 100 to 300 euros, depending on the insurance company and budget. Phytotherapy contributes about 20 to 30 percent of this, as herbal preparations are more often included in global budgets. AOK NordWest, with its 500-euro budget, spreads the costs over several services, so that the share for a single direction is less than 100 euros per case.

Medical consequential damage caused by the use of non-evidence-based services cannot be quantified exactly, as large-scale long-term studies specific to statutory health insurance are lacking. Nevertheless, there are clear risks from the delay of evidence-based therapies. Patients who initially choose homeopathic, anthroposophical or phytotherapeutic approaches lose valuable time in the case of serious diseases such as tumors. Oncology reports document cases in which early conventional medical intervention was missed and tumors progressed. This leads to higher treatment costs in later stages, poorer chances of recovery and additional complications such as metastases or necessary intensive care stays. Phytotherapy has specific risks: Possible interactions with conventional medicines can lead to undesirable effects, especially if dosed uncontrollably or in combination with other drugs. Herbal preparations can cause liver or kidney damage or reduce the effectiveness of chemotherapy if they are not evidence-based.

An analysis by the Techniker Krankenkasse from 2017 compared insured persons with homeopathic treatment with a control group. Over 33 months, the homeopathy group incurred an average of 2000 euros higher costs per case. Of this, around 800 euros were attributable to additional social costs due to 3.3 additional days of absence from work. The total costs were 12,414 euros compared to 10,429 euros in the control group. Higher expenditures were found for all diagnoses, indicating delayed or complementary conventional treatments. Experts estimate that indirect follow-up costs due to avoidable disease progression can exceed direct expenditure many times over. In cancer diagnoses, a delay of months can lead to a doubling of treatment costs, as advanced stages require more expensive therapies such as immunotherapies or palliative measures. Other risks include spreading misinformation about efficacy, leading to neglect of effective drugs for side effects. Although homeopathic remedies are highly diluted and rarely cause direct pharmacological damage, the indirect consequences – prolonged courses of the disease, avoidable hospitalizations and reduced quality of life – place an additional burden on the system.

A detailed calculation of the total burden takes into account direct and indirect effects. Direct expenditure of 20 to 25 million euros annually corresponds to a share of less than 0.008 percent of total expenditure of 326.85 billion euros in 2024. Indirect costs due to consequential damage can be conservatively estimated at three times as much, based on the TK analysis and oncological reports. This results in a potential total burden of 60 to 75 million euros per year. With an assumed delay rate of ten percent of users with serious illnesses and additional costs of 10,000 euros per case (due to advanced therapies), another 20 to 30 million euros add up. A complete cancellation would not only save the direct 20 to 50 million euros, but also reduce indirect costs and free up resources for evidence-based care. In the context of the GKV financial budget, which closed 2025 with a surplus of 3.5 billion euros, these amounts seem symbolic, but they underline prioritization issues.

Political debates about these benefits have been going on for years. Health Minister Lauterbach called for the cancellation of homeopathy as a health insurance benefit in 2024 in order to save 20 to 50 million euros. The Greens called for similar steps in 2025 to direct resources towards demonstrably effective measures. The health insurance companies argue with patient demand and competition, but admit that the financial significance is low. Nevertheless, they continue to finance the services because they bind insured persons and achieve marketing effects. A nationwide regulation could eliminate regional inequalities and create clarity.

In summary, despite a lack of or insufficient evidence, the statutory health insurance funds finance services such as homeopathy, anthroposophic medicine and phytotherapy, including AOK in widely varying regional variants of 25 to 500 euros per year. The direct financial burden of 8.7 to 25 million euros per year remains marginal in relation to the total budget of over 326 billion euros, but potential medical consequences from treatment delays and indirect costs of up to 75 million euros could cause higher burdens in the long term. Removing them would free up resources for evidence-based care and reduce inequalities. The debate shows the balancing act between patient wishes, competition and scientific rationality in the German health care system.

This report is based solely on official information on expenses, reimbursement models and analyses. All figures are derived directly from developments from 2017 to 2025 and adapted to the latest available status.

The article was originally published by LabNews Media LLC.

Editor: X-Press Journalistenbüro GbR

Gender Notice. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple naming and gendered designations are used for better readability. ected.