[The health insurers' perspective on defining and managing healthcare needs]

The German healthcare system, despite its high performance, fails to achieve the goal of needs-based service provision. Supply-induced demand, regional disparities and misaligned financial incentives lead to overuse, underuse and misuse of healthcare services. Planning instruments are often based on data reflecting actual utilization rather than capturing the true healthcare needs of the population. The aim of this article is to analyze how needs orientation can be systematically achieved through new planning, financing and organizational frameworks. Drawing on current legislation, empirical data and sector-specific policy positions, the study examines which structural transformations are required. The analysis demonstrates that the existing legal framework does not enable needs-based service regulation. A shift away from a supply-driven system towards a planning approach that incorporates morbidity, demographic trends, accessibility and quality of care is essential. Central levers for reform include a quality-oriented hospital restructuring, appropriately designed cross-sectoral care facilities, a comprehensive primary care system, needs-oriented emergency care, consistent oitpatient substitution of inpatient cases, flexible regional decision-making capacities and cross-sectoral needs-based planning with unified service categories and quality requirements, involving regional stakeholders. A scientific instrument for needs assessment can align planning and financing, thereby enabling more reliable, efficient and patient-centered care. Only an integrated reform strategy will enable resources to be used efficiently, reduce excess capacities and align healthcare provision with the actual needs of the population.