German doctor loses court fight over digital health network funding shortfall
A Stuttgart orthopedist has lost her legal battle over telematics infrastructure (TI) funding after challenging a €3,150 subsidy. The Baden-Württemberg State Social Court (LSG) ruled that flat-rate payments for TI costs do not need to cover all expenses in full.
The case centred on whether doctors should receive complete reimbursement for connecting to Germany's digital health network, which links practices, pharmacies, and insurers.
The dispute began when the orthopedist contested her remuneration notice for the third quarter of 2018. She argued that the €3,150 TI subsidy failed to cover her actual costs, which totalled nearly €3,900. Her claim for full reimbursement was initially supported by the Stuttgart Social Court (SG).
The LSG later overturned that decision. Judges found no legal requirement for flat-rate payments to be fully cost-covering. They also ruled that asking healthcare providers to share in the TI's introduction costs was reasonable and did not violate constitutional rights.
While the court noted that a purely symbolic payment at an extremely low level could raise concerns, the current subsidy rates did not meet that threshold. The TI system, managed by Gematik under the Federal Ministry of Health, incurs annual operational costs of around €100 million. Practices receive monthly flat-rate reimbursements—such as €200.22 plus €7.48 per electronic health card reader—rather than full expense coverage.
The Association of Statutory Health Insurance Physicians (KV) was named as the defendant in the case, as it administers the funding distribution to doctors and pharmacies.
The ruling confirms that healthcare providers must accept partial subsidies for TI connection costs. The LSG's decision sets a precedent, clarifying that flat-rate payments need not match expenses in full. Funding responsibility remains with Gematik, the health ministry, and the GKV-Spitzenverband, the national association of health insurers.
