The continuous high cost pressure in the German healthcare system, along with medical and technological advancements, demographic changes, and the resulting multimorbidity into old age, presents the healthcare system with new challenges to remain viable in the coming decades. The call for a relaxation of the sectoral separation and for more competition among insurers and, above all, among service providers, in terms of maintaining solidarity and comprehensive care, necessitates the search for new solutions. Based on the existing regulatory framework, the author examines to what extent "selective contracting," meaning the ability to enter into care contracts with selected service providers, can serve as a competitive instrument to achieve increases in efficiency and effectiveness, and what prerequisites are required.