GKV Contribution Rate Stabilization Act: This is how patient transport becomes a risk for taxi companies.

Those who regularly transport patients to dialysis, to chemotherapy, or to outpatient treatment know the bill: the vehicle must be available, the driver is paid, waiting times must be factored in. In addition come fuel, insurance, maintenance and administration. Whether the trip pays off in the end does not depend solely on the distance travelled. Also decisive is what the statutory health insurance reimburses for it.

Exactly at this point the GKV Contribution Rate Stabilization Act comes into play. The federal government aims to limit the expenditures of the statutory health insurance (GKV) and stabilize the contribution rates. The law was passed by the Bundestag on July 10, 2026, drafted on July 24, and proclaimed in the Federal Gazette on July 29. It is therefore no longer merely a political declaration of intent. The essential regulations have been in effect since the end of July; others will take effect on January 1, 2027. For the taxi and rental car sector, this marks the beginning of a phase during which the economic consequences are likely to become more visible.

Reform with consequences for patient transport

The basic idea of the reform is understandable at first: The expenditures of the statutory health insurance funds should in the future no longer rise permanently faster than their revenues. To achieve this, the legislator limits the annual remuneration increases in the various service areas. What matters are the actual cost developments in the respective area or the so-called base wage rate — with the lower value generally applying. For the years 2027 to 2029 there is an additional deduction of one percentage point. This affects not only medical practices, hospitals or other health service providers. Patient transport is also covered by the statutory limit. Because § 133 of the Social Code Book V (SGB V), which regulates the remuneration of patient transport services, refers to the provisions on contribution-rate stability under § 71 SGB V. This ties the development of remuneration for patient transport more closely to the legally defined limits.

For the taxi industry this is a significant change in the economic framework. Until now, negotiations with the health insurance funds focused mainly on regional transport contracts and the prices agreed therein. Going forward, the negotiating partners must also orient themselves to a tighter statutory corridor. How much room there is for higher remuneration will thus not depend solely on the costs of the companies. The taxi industry does not dispute that the GKV must get its expenditures under control. But it asks whether a general cap on the development of remuneration adequately reflects the actual conditions of patient transport.

When costs rise faster than revenues

Taxi companies must pay their drivers, finance vehicles and maintain operations even when a vehicle is waiting for the return trip or a connecting ride is missing. If wages, insurance premiums, energy and repair costs rise faster than the remuneration, margins shrink. This can be particularly noticeable with regular patient transports, which do generate predictable revenues but do not automatically yield high profits. For 2027, a recent industry analysis cites a key rate of change of 3.42 percent. This figure describes the legally relevant remuneration cap and is not equivalent to an automatically granted price increase for every single ride. The specific fees still depend on the respective agreements and their legal framework. That is crucial for the calculation. A company cannot simply assume that its revenues from patient transports rise to the same extent as operating costs. Conversely, the statutory cap does not mean that all remunerations are increased by 3.42 percent across the board. Rather, it limits the leeway for corresponding agreements.

The situation can become particularly difficult for businesses whose business heavily depends on patient transports. Those who regularly transport patients to fixed appointments need reliable capacity. Drivers and vehicles cannot be taken out of operation at short notice simply because a single trip yields less than planned. In addition, waiting times during treatments and empty runs are not always adequately reflected in the remuneration. Regional differences also play a role. In a big city, trips can potentially be bundled more efficiently than in rural areas. There, long travel distances, low vehicle utilization and missing connecting orders can further burden profitability. A general remuneration cap can only partly account for such differences.

Taxi companies warn of consequences for care provision

The Federal Association of Taxi and Rental Cars (BVTM) has therefore, together with numerous state associations and other organizations of the mobile trades, prepared a joint statement on the law. The alliance wanted to bring the impact of the planned regulations on patient transport and the economic viability of the enterprises into the parliamentary process. The associations pointed out that their companies conduct millions of medical transports per year nationwide.

In essence, it is about more than the profit margin of a single operation. Medical transports are part of medical care. Patients who cannot reach treatment independently by public transport for health reasons depend on suitable means of transportation. The legal basis for this can be found in § 60 SGB V. The statutory health insurers cover travel costs when the transport is necessary for compelling medical reasons and the legal requirements are met. For taxi or rental car trips, the billable amount under § 133 SGB V is generally used as the basis. For certain outpatient treatments there are special conditions and, where applicable, authorization requirements.

If patient transport becomes permanently not profitable for companies, the patients' need, however, does not disappear. In the worst case, operators withdraw from this business field or reduce their capacities. Then the question arises who will take over the trips in the future and whether the care provision will be reliably guaranteed in all regions. This is initially a risk, not an automatic consequence of the law. How strong the effects will be will largely depend on how actual costs develop and which reimbursements can be agreed in the upcoming negotiations.

Co-payments rise – and the burden remains

Another change concerns the co-payments of the insured. They generally amount to ten percent of the travel costs, at least five and at most ten euros per trip. As part of the reform, the limits will be raised starting in 2027 to at least 7.50 and at most 15 euros. The co-payment can thus rise for patients, while the remuneration of service providers is simultaneously more tightly limited.

For taxi companies this is not just a question of money. The operators must record and bill the co-payments correctly. With regular trips, several treatments or changing contacts, this can cause additional administrative burden. If there are payment problems or faulty billing, this further burdens the already tight calculation. The industry is therefore also discussing direct handling of the co-payments by the health insurance funds. That could relieve the companies administratively. However, such relief would not be a substitute for economically viable remuneration of the transport service.