Diagnostics as a Service for laboratories: how a German laboratory gets self-pay work through a partner network

You already run the tests, so Diagnostics as a Service is the arrangement on the other side of your work. In that arrangement a brand sells a blood test under its own name. Around that sale, a network organises the ordering, the collection, the logistics between the two, and the software that ties them together. The analysis is done by an accredited laboratory, which is the party this article is written for.

For a laboratory the question is not whether it can run the tests, because it already does. The question is where the demand comes from. Three published developments in the German market bear on that question, so the first section sets them out.

What has happened to laboratory income in Germany?

Spending has grown, billed statutory volume has fallen, and the fee schedule itself has changed. The first two of those developments are documented in a peer-reviewed status report on German laboratory diagnostics published in April 2025.¹

The spending figures are the first of the three. Laboratory services cost 12.9 billion euro in 2022, which was 2.6 percent of all German health spending and about 150 euro a head. That followed growth of 55 percent over the preceding decade.¹ The payers are the two you would expect. Statutory insurance paid 65 percent of that spending in 2022, and private insurance paid 19 percent.¹

Billed volume moved the other way over the same years. The number of billed services under the statutory laboratory chapters was 1.49 billion in 2022, against 1.58 billion in 2017.¹ So the statutory sector spent more while billing fewer services.

German laboratory spending was 12.9 billion euro in 2022, about 150 euro a head, while billed statutory services fell from 1.58 billion in 2017 to 1.49 billion in 2022. Source: Vogeser, Schumacher and Bühling, Statusbericht 2024, GMS German Medical Science volume 23, 9 April 2025.

The third development is in the fee schedule. Since 1 January 2025 transport, materials and electronic ordering have been paid as separate flat rates instead of out of the test valuations. The valuations were cut to match.²

What that cut does to a laboratory's income was simulated by the laboratories' own association in March 2025. The simulation was modelled on sixty-four laboratories' billing data from 2024. Sixty-six percent of them would be paid less on the first-quarter data, and sixty-nine percent on the second.³ Two more numbers from the same simulation give its size. The worst case in the sample would be paid 17.2 percent less, and the association puts the effect across the whole sample at about 36 million euro a year.³

In a sample of sixty-four laboratories, sixty-six percent would be paid less on the first-quarter data and sixty-nine percent on the second-quarter data, with a worst case of minus 17.2 percent. Source: ALM e.V., ALM Aktuell SPEZIAL 03/2025, which are the trade association's own figures on its own members.

Those figures come from a trade body reporting on its own members, so read them as the association's own rather than as a neutral measurement. They are here because we have found no other published analysis of the effect.

Why does a laboratory not deal with the person directly?

Because of how the German model is built. The person does not come to the laboratory but goes to a treating practice, and for statutory work the laboratory bills a regional association of the statutory insurance system rather than the person.⁴

Private work is the exception to that chain. A privately paying person is billed directly rather than through the statutory system.⁴ Applied to a laboratory, that would make self-pay the one place where a direct relationship with an individual is possible. The source describes the German model in general terms rather than saying so of laboratories, so treat that step as our reading.

The consequence is that a laboratory wanting self-pay volume has to build everything a consumer business needs before a sample arrives. That means the demand, the booking, the person-facing product, the invoicing for many small amounts, and the support when something goes wrong.

What does a network supply, and what does a laboratory keep?

The network supplies everything around the analysis, and the laboratory keeps the analysis itself and the responsibility for it. That division matters most in the contract, because it decides who answers for a wrong result as much as who does the work.

What a Diagnostics as a Service network supplies

Everything a laboratory would otherwise have to build for itself, which is the list from the section above.

• The demand, because the brand sells to its own customers rather than to yours.
• The person-facing product, which is the booking, the app and the way a result is explained.
• The draw network, so somebody can have blood taken near where they live.
• The logistics between the draw and your door.
• The interface that accepts the order and returns the result, with codes and units on it.
• The contract, so the brand signs once rather than with several vendors.

None of that is analysis, but without it there is no self-pay customer for a laboratory to have.

What a laboratory keeps in a Diagnostics as a Service arrangement

The part that cannot be bought in. That is the analysis itself, the accreditation and the quality system behind it, the medical validation of a result, and the professional responsibility for it.

Of those four, medical validation is the one worth naming explicitly in the contract. As we read the German model, that responsibility stays with the laboratory whatever an agreement says. No regulator has published a statement either way, so your state medical chamber is the body that settles it.

The network brings the demand, the booking and person-facing product, the draw network, the logistics, the interface and the one contract. The laboratory keeps the analysis, the accreditation, the medical validation and the professional responsibility. This split is a reading of how such a network divides the work rather than a published rule.

What nobody publishes

Three things a laboratory reasonably wants to know before joining anything are missing from the sources we searched. Each bullet below says where we looked.

• We could not find a published count of the medical laboratories operating in Germany. The status report gives numbers of specialist physicians and of hospital departments rather than a national count.¹
• We could not find a published figure for spare analytical capacity in German laboratories. The only capacity reporting we found was the coronavirus testing series, and it has since stopped.
• We could not find a published figure for the self-pay share of German laboratory work. The status report gives the statutory and private insurance shares and does not break the remainder out, so a self-pay share worked out by subtraction would be wrong.¹

The second of those gaps you can fill yourself. What share of your own analysers is idle on a Tuesday afternoon is something you know better than any published source.

What should a laboratory ask a network?

Five questions, ordered by how much of your business the answer decides.

• What happens to the volume if the brand leaves?
• Where does the demand come from, and is it yours or theirs at the end of the contract?
• Who validates a result medically, and is that written down?
• Which codes and units does the interface expect, and who does the mapping?
• What arrives at our door, and in what state and at what hours?

The first three decide what the arrangement is worth and who answers when a result is wrong. The last two are operations rather than terms.

Where Aniva is on this

Aniva runs the ordering, the kits, the collection and the results interface, while the analysis is done by a laboratory partner. The collection network is Aniva's own rather than a subcontracted one. The laboratory, the kits, the logistics, the software and the data agreement are one contract rather than five. The customer meets the partner's brand and no other.

This suits a laboratory with spare capacity and no consumer channel. If that describes yours, book a demo.

Notes and sources

1. Vogeser M, Schumacher T, Bühling F. Medizinische Labordiagnostik in Deutschland, ein Statusbericht 2024. GMS German Medical Science, volume 23, published 9 April 2025. Source of the spending, payer split, per head and billed volume figures, of the counts of specialist physicians and of hospital laboratory departments, and of the statement that the total number of laboratory examinations carried out in Germany each year is not publicly available. doi.org/10.3205/000337
2. Kassenärztliche Vereinigung Rheinland-Pfalz, Laborreform, 19 December 2024, describing the end of cross-financing from 1 January 2025 and the matching reduction in valuations. www.kv-rlp.de/nachricht/laborreform
3. ALM e.V., ALM Aktuell SPEZIAL, Umsetzung der Laborreform 2025, issue 03/2025, reporting the simulation on sixty-four laboratories' billing data, the share that would be paid less, the worst case and the annual effect across the sample. These are the association's own figures. www.alm-ev.de/wp-content/uploads/2025/03/ALM-Aktuell-Spezial-Laborreform-0325.pdf
4. Trillium Diagnostik, Das komplizierte deutsche B2B-Geschäftsmodell, 2015, describing that the person goes to the treating practice rather than to the laboratory and that statutory work is billed through the regional association. www.trillium.de/zeitschriften/trillium-diagnostik/archiv/ausgaben-2015/td-32015/titelthema/die-zukunft-der-labordiagnostik/das-komplizierte-deutsche-b2b-geschaeftsmodell.html

This article describes the German laboratory market and how a diagnostics network divides the work. It is general information and not legal or commercial advice, and any arrangement is a question for your own adviser.