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Private health insurance is no longer socially acceptable

The discussions about a possible abolition of private health insurance (PKV) do not stop. Now the head of the umbrella organization of statutory health insurance companies (GKV), Dr. Doris Pfeiffer's position. "I am convinced that the PKV business model will not be sustainable in the long term," she said in an interview with the "Rheinische Post".

Private health insurance is a phase-out model Pfeiffer criticized that the black and yellow federal government is increasingly helping the PKV, since the system would no longer work without numerous concessions. For example, the PKV benefits from the drug saving package that was actually installed for the statutory health insurers. Even privately insured people are becoming increasingly skeptical: in 2011 alone, around 160,000 people switched from private to statutory health insurance. It would probably be far more if the switch back were closed to most private health insurers due to numerous legal hurdles.

According to Pfeiffer's opinion, the PKV business is an end-of-life model that does itself. It can be expected that more and more companies will withdraw from the health insurance business in the future, she explains to the newspaper. "The PKV obviously has a problem with its existence. I am convinced that the PKV business model is not sustainable in the long term. The PKV has been struggling with increasing expenditure for years. The expenditure increases are higher than in the statutory health insurance. The PKV has no instruments to get this under control, ”she told the RP.

Practice fee to be maintained Regarding the practice fee, the head of the National Association of Statutory Health Insurance Funds said that this could only be abolished if there were alternative sources of income. The practice fee would generate around two billion euros annually. One has to think about the future, warns the association chairwoman. The surpluses from the previous year were not sufficient for this despite billions of euros. Before introducing the practice fee, experts hoped to reduce unnecessary doctor visits. However, this was not achieved, as evaluations showed. Pfeiffer explains that the coalition agreement contains an order to reform the practice fee. With such a reform, however, it is essential to ensure that the revenue is maintained. In addition, the steering effect had to be improved without stopping the doctor from making necessary visits. So far, the health insurance funds have not brought in their own proposal. Politicians have introduced the practice fee. Now it must also initiate appropriate reforms.

Pfeiffer rejects cut in federal subsidy Finance Minister Schäuble (CDU) plans to withdraw two billion euros from the health fund next year. Pfeiffer rejects this approach: “For many years we have been talking about the fact that we have to operate sustainably in the social systems. We have a so-called “sustainability reserve” in pension insurance, which is between 0.2 and 1.5 monthly expenses. If this one and a half monthly expenses are exceeded, the contribution rate will be reduced. Transferred to health insurance, this would mean that the reserves could total up to 22 billion euros. “We are currently in the GKV with a surplus of around 19 billion euros. That means that I see no reason at all to talk about the distribution of funds or the reduction of federal subsidies. ”She believes that a statutory GKV reserve, like pension insurance, makes sense. However, the amount still needs to be discussed.

Pfeiffer adds that the federal subsidy is used to finance non-insurance benefits, which include sickness benefits, maternity protection and non-contributory co-insurance for children and spouses. However, since such expenditure had not been reduced, she saw no reason to justify the reduction. In addition, there is an annual increase in expenditure of 3.5 percent. In contrast, revenues would only increase by 1.5 percent. Overall, there is a gap that cannot be filled by the current exceptional situation.

In 2011, however, expenditure rose by only 2.5 percent. Pfeiffer explains the slight decline due to the savings in pharmaceuticals. In addition, the administrative costs of the health insurance funds have decreased and the costs for doctors and hospitals have not increased too much.

However, the public also has the impression that the health insurers save on services in order to avoid additional contributions. It seems that fewer and fewer mother-father-child cures are approved. “We have been discussing the topic for years. The public impression that too many mother-father-child cures are rejected is not correct. A medical reason is required to approve such a cure. Often, however, only social, not health, indications are given, ”explains the head of the umbrella organization of the GKV. It was only last year that the framework conditions for approval of the cures were clarified by agreement with organizations such as the mother's recovery center, in order to create more clarity.

Is the Dutch POS system a role model for Germany? The health economist Prof. Dr. Jürgen Wasem from the University of Duisburg-Essen believes that a uniform system based on the Dutch model is also suitable in Germany. In 2006 there was a major reform in the Netherlands to align private and statutory health insurance. Health insurance is compulsory for every Dutchman. For their part, the health insurance funds may not deny basic health care services to any citizen. The financing of the model is based on two different lines. The citizen bears almost half of the health insurance costs. The amount is levied regardless of the average annual income, age, gender and state of health. The other half is paid by the employer depending on income. The self-employed, on the other hand, have to bear both shares themselves. Government subsidies exist for insured persons with low incomes.

The umbrella organization of private health insurance (PKV) considers the Dutch health insurance model to be unsuitable. According to lobbyists, the model would result in much more restrictions in the range of services and rising costs due to the market concentration on a few providers. (ag)

Read on:
CDU health experts want to abolish the PKV
PKV: For nonpayers only emergency care
Health insurance companies: Non-payers cause losses
Private patients flee to the health insurance companies
Health insurance: additional contributions will come again
Complaints about an increase in private health insurance contributions
Health insurance: what's changing in 2016351a2cc0b08c03

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  1. Wahid


  2. Garrad

    It is about something different and the idea of ??keeping.

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