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Do private German health insurers invest their capital reserves of €353 billion according to environmental, social and governance criteria?
  1. Frederick Schneider1,
  2. Julia Gogolewska2,
  3. Klaus-Michael Ahrend3,
  4. Gerrit Hohendorf4,
  5. Gerhard Schneider1,
  6. Reinhard Busse5,
  7. Christian M Schulz1,2
  1. 1Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, München, Germany
  2. 2KLUG–Deutsche Allianz Klimawandel und Gesundheit, Berlin, Germany
  3. 3Fachbereich Wirtschaft, Hochschule Darmstadt, Darmstadt, Hessen, Germany
  4. 4Department of Medical Ethics and History, TUM School of Medicine, Technical University of Munich, München, Germany
  5. 5Fakultät Wirtschaft und Management, Technische Universität Berlin, Berlin, Germany
  1. Correspondence to Dr Frederick Schneider, Anesthesiology and Intensive Care, TUM School of Medicine, München 81675, Germany; frederick.schneider{at}


Background To prevent the planet from catastrophic global warming a reduction of greenhouse gas emissions to net zero is required. Thus, divestment from fossil fuels must be a strategic interest for health insurers. The aim of this study was to analyse the implementation of environmental, social and governance (ESG) criteria in German private health insurers’ investments.

Methods In 2019 a survey about ESG strategies was sent to German private health insurance companies. The survey evaluated investment strategies and thresholds for the exclusion of sectors and business practices, as well as company strategies for sustainable business development.

Findings Given their business reports, German private health insurers manage assets of more than €350 billion. 11 of 40 insurance companies provided quantitative data, 10 refused to answer. According to quantitative data, €66 billion of assets is managed according to any ESG criteria; this equals an average of 76% of each company’s bonds. None of these insurers excluded the production and sale of fossil fuels. All excluded coal mining but only at high thresholds. For €226 billion, no data were provided.

Interpretation The findings are in contrast to the expected intrinsic economic interest of the insurers to stop global warming and improve public health. The majority of assets are managed in a highly problematic manner, especially the absence of capital allocated in fields contrary to medical ethics (eg, firearms, armour) cannot be presumed. Lack of transparency is a major problem that limits clients in choosing the insurer who has the most advanced ESG criteria.

  • applied and professional ethics
  • environmental ethics
  • health care economics
  • interests of health personnel/institutions
  • public health ethics

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  • Contributors FS and CMS designed and conducted the study and drafted the manuscript. FS performed the data analysis. KMA and RB supervised the study. JG, KMA, GH, GS and RB revised the manuscript for important intellectual content. All authors interpreted the data analysis and critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Not all participating insurance companies provided consent to publish the provided data along with their name, thus anonymised data are available from the corresponding author for reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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