In Germany, the cost of homeopathy will no longer be borne by the healthcare system

From 30 July 2026, as provided for by the law published on 29 July, compulsory health insurance funds in Germany will no longer be able to reimburse homeopathy and anthroposophic medicine through the optional benefits with which some of them have hitherto sought to attract new members; from 1 January 2027, the ban will come into full effect and will be definitively extended to any form of supplementary cover or supplementary contract that provided for such funding. The German decision establishes a simple principle: a person remains free to purchase a homeopathic product or to consult a doctor who practises homeopathy, but cannot expect the cost to be borne by the community of insured persons. The freedom to believe in the benefits of a treatment remains intact; what is removed is the right to pass on the cost to the healthcare system when the specific benefit has not been demonstrated.

Homeopathy was not part of the standard benefits guaranteed to all German insured persons. Its inclusion in the public system depended primarily on the discretion granted to individual health insurance funds to offer additional reimbursements. Some funds reimbursed products purchased from pharmacies, whilst others covered consultations and the extensive homeopathic case history, during which the doctor gathers information on the patient’s symptoms, habits and personal characteristics in order to identify the remedy deemed most appropriate. There were also specific contracts through which health insurance funds organised care pathways including homeopathic services. The reform closes these channels. Homeopathic and anthroposophic medicines are excluded from the entitlement to pharmaceutical provision covered by compulsory insurance. From 1 January 2027, health insurance funds will not be able to include them even among their supplementary benefits, nor will they be able to fund related professional activities through special contracts. The exclusion therefore applies to both products and treatments, including the doctor’s time billed as homeopathic care.

The reasoning set out in the preparatory documents for the reform is explicit. According to international standards of evidence-based medicine, there is no reliable scientific evidence of homeopathy’s efficacy beyond the placebo effect. The same assessment applies to anthroposophic treatments. In the absence of a proven clinical benefit, their funding is not considered compatible with the health insurance funds’ obligation to use resources for interventions of medical benefit. Government estimates put the annual cost of homeopathy to the health insurance system at around 40 million euros, including medicines and related professional services. The figure remains uncertain because payments were spread across various schemes and were not always recorded in a separate category. In the overall German healthcare budget, this is, however, a limited sum; nevertheless, it is precisely the relative modesty of the savings that highlights the significance of this decision. Homeopathy is not being excluded from public funding because it alone could jeopardise the German healthcare system’s finances. It is being excluded because even a modest expenditure becomes unjustifiable when it is used to pay for a treatment that has failed to provide the evidence required of any other therapy. The economic cost is also accompanied by an institutional effect: reimbursement by a health insurance fund confers a legitimacy on the product that the results of clinical trials do not recognise.

For many patients, the availability of reimbursement could be interpreted as confirmation of efficacy. If a treatment is covered by health insurance, it is natural to assume that it has undergone an assessment comparable to that required for other treatments. In the case of homeopathy, this assumption was incorrect. Health insurance funds often offered it for commercial reasons, as covering homeopathic remedies could make an insurance policy more attractive to a section of the population. The reform prevents competition between health insurance funds from turning the popularity of a therapeutic belief into a criterion for allocating healthcare resources. As is obvious, despite the figure of 10 million consumers constantly bandied about across Italy by supporters of homeopathy, a treatment may be sought by many citizens without this necessarily conferring clinical efficacy. Consumer consensus measures the prevalence of a practice, whilst therapeutic evidence requires studies capable of distinguishing the specific effect of the treatment from the natural course of the disease, fluctuations in symptoms and the patient’s expectations.

As is well known, homeopathy is based on the idea that substances capable of causing symptoms in a healthy person can cure them if diluted repeatedly, often to the point where they no longer contain any active molecules. The available evidence shows no effects beyond the placebo effect. Anthroposophic medicine, developed in the 20th century by Rudolf Steiner and Ita Wegman, integrates homeopathy with medical practices and spiritual concepts. In both cases, the German reform applies the same principle: public funding requires verifiable evidence of efficacy, not the traditional recognition of a discipline. In fact, Germany had long had regulations granting homeopathy and anthroposophy a special status. The definition of ‘special therapeutic approaches’ had made it possible to preserve a regulatory space in which homeopathy and anthroposophy continued to be regarded as legitimate healthcare practices even without fully meeting the standards applied to other treatments. The new legislation reduces this protection at the crucial point of public reimbursement.

In recent years, many regional medical associations in Germany have also removed homeopathy from their lists of recognised additional qualifications. The current decision is therefore part of a process in which professional bodies and the legislature are realigning the recognition of homeopathy with the quality of the available evidence. Its German origins and its long-standing presence in the national healthcare culture are not considered sufficient grounds for continuing to fund it. The German case also illustrates the difference between marketing authorisation and the right to reimbursement. A product may be legally registered as a medicinal product and remain available in pharmacies without this implying recognition of proven therapeutic efficacy. Marketing authorisation sets out the conditions under which the product may be marketed; reimbursement commits public resources and requires further justification, based on the benefit to the patient.

This distinction is often obscured in the Italian debate. The presence of homeopathic medicines in pharmacies and their regulation under pharmaceutical legislation are presented as if they constituted proof of their efficacy. Legal recognition of this category merely indicates that these products are subject to specific rules governing their manufacture, registration and sale. It does not prove that they cure the conditions for which they are purchased. In Italy, homeopathic medicines are not normally reimbursed by the National Health Service, but their purchase qualifies for the tax deduction provided for healthcare expenditure. Taxpayers may deduct 19 per cent of the expenditure from their tax bill, in accordance with the rules applicable to medicines. A portion of the cost is therefore passed on to the general tax system through a reduction in state revenue. The method differs from the German reimbursement system, whilst the economic principle remains similar: public money is used to facilitate the purchase of products with no proven specific efficacy.

The German approach makes the Italian anomaly all the more evident. In Hahnemann’s homeland, it has been recognised that using public funds to finance a treatment unable to demonstrate efficacy beyond that of a placebo constitutes an unacceptable waste of resources. Italy, however, continues to grant tax relief for such treatments and is debating proposals aimed at strengthening their institutional recognition. The difference between the two approaches lies in the criteria by which a democracy decides which health-related claims deserve to be supported by the community.