Inside Germany’s Healthcare Reform: An Interview with Daniel Cardinal, Techniker Krankenkasse

Techniker Krankenkasse (TK) is Germany’s largest statutory health insurer, operating in one of Europe’s most complex healthcare systems. To better understand how this system is evolving, I met up with Daniel Cardinal, Head of Innovation at TK.

Our conversation focused on the structural pressures reshaping German healthcare—from demographic change and appointment shortages to the growing need for structured patient navigation and digital assessment. We also explored how digital infrastructure is being built at scale, and what this means for patients, providers, and technology vendors working within the system.

What stood out most is how quickly the conversation has shifted: ideas like care navigation, once a controversial topic, are now becoming central to how stakeholders think about access, responsibility, and the future design of care pathways.

I’ve transcribed and paraphrased the questions and answers below, but you can also watch the full interview from HLTH Europe on YouTube.

Primary care reform in Germany. What’s happening in the healthcare system right now?

Daniel Cardinal: There’s a cultural shift happening in German healthcare right now. In the past, people were used to getting everything, everywhere, whenever they needed it—it was all covered. Nowadays, because of demographic changes, the system is under pressure. People can’t get appointments like they used to. So what we need is a navigation through the system.

Is access to care becoming the biggest source of friction for patients in Germany today?

Daniel Cardinal: Yes, in the past, I wouldn't have had to pay anything, I could go anywhere I liked, and I would get an appointment. This has changed dramatically.

Where do you expect the biggest impact of Germany's healthcare reforms to be felt over the next few years, and how will they improve patient care?

Daniel Cardinal: What we need is two different things. First of all, we need to improve access to the system—not just perceived access but actual measurable access to the system. And the second thing we really need is better clinical pathways, which lead to better clinical outcomes.

How does innovation in German healthcare stand compared to other countries in the EU?

Daniel Cardinal: Actually, I think we are doing pretty well right now. For instance, we have an electronic patient record for every statutory health-insured person in Germany. That means we have 72 million electronic patient records, and we built this in record time once we really chose to do it. We can do it, and the pace is accelerating. People see the need for change, and as technology improves access and delivers better healthcare experiences, adoption will scale.

What does a healthcare “front door” look like in practice, and who should be responsible for providing it?

Daniel Cardinal: "Front door" in one context means your first contact point to the system. I think insurers should be at least one front door to the system, and we will see legislation this fall that will allow insurers to provide a digital front door directly through their apps.

If we are talking about an assessment of your health status prior to the first appointment in the system, this means "front door" to me, like the first contact point where your medical needs are really identified, and then you enter the system.

Why should it be the insurers? In my opinion, it's pretty clear. We have a legal obligation; we have to provide healthcare to our customers, which is sufficient, appropriate, and economically viable. And we are a nonprofit, so we’ve got no economic interests in doing this, and we are highly regulated by the government. So who should do it if not us?

What is the long-term potential of digital health assessment? What value can you see?

Daniel Cardinal: In my opinion, in a couple of years, we will be at a point where we get data-driven, personalized healthcare for all of us. So you enter my front door, I provide you with an assessment, and I show you the possibilities from self-care up to hospitalization in the next 20 minutes. Right now, we’ve got one huge issue, and that's the liability of the system. Because right now, liability disappointingly leads to a point where most of the contacts really, in the end, lead to an appointment, and we need to change this based on medical knowledge.

Do you think the current challenge is mainly a question of system design and liability rather than the technology itself?

Daniel Cardinal: I guess right now it's by design and by liability. But the good news is we can change this, because it will become a statutory system in Germany pretty soon. And once that’s in, we can talk about all the other things, because then we can really navigate the patient, the customer, the citizen, through the system. The system will be liable for the clinical pathway, and not the single doctor, the single product, or the single software.

When evaluating new vendors and startups, what are the key factors you look for before deciding to collaborate?

Daniel Cardinal: First of all, you need to have some knowledge of the German system, which is really complicated. And we really appreciate it if someone shows up who already knows how they could get reimbursement. And the second point is to come with low expectations. And low expectations in that context means start small, scale up. If you come with the expectation—and we do see this quite often—that startups come and say, "I want to be reimbursed by 70 million insurees of the German statutory health insurance," it's not going to happen. It's a very long run. It's a long-distance run. So if you start small, you scale up, and then one day you will be reimbursed by every GKV. That's the way you do it.

When it comes to AI, do you apply any specific criteria when evaluating AI-based healthcare solutions compared to other healthcare technologies?

Daniel Cardinal: Honestly, right now we don't. We are still scanning the market, and what we are looking for is an AI that is safe regarding European legislation, and that's most important—medical device certification, C5 certification, etc.

When it comes to AI, do you apply any specific criteria when evaluating AI-based healthcare solutions compared to other healthcare technologies?

Daniel Cardinal: Honestly, right now we don't. We are still scanning the market, and what we are looking for is an AI that is safe regarding European legislation, and that's most important—medical device certification, C5 certification, etc.

Closing thoughts

Germany’s approach to healthcare reform in the context of AI feels notably pragmatic. Rather than moving slowly or waiting for perfect clarity, we are already seeing legislation and operational frameworks evolve at a pace that, in some areas, is ahead of other global healthcare systems.

Having the opportunity to speak with Daniel and understand these changes from an inside perspective was a real privilege, and it offered a valuable window into how a large, complex system is actively adapting to new technological and societal pressures.

With thanks

A big thank you to Daniel Cardinal and the wider Techniker Krankenkasse team for taking the time to share their insights on the future of healthcare access and digital transformation in Germany.

If you’re working on similar challenges around healthcare reform in your region, feel free to contact me on LinkedIn—I’m always open to continuing the conversation.

BL/EN/2026/06/30/1