CDU health expert wants to abolish the PKV

CDU health expert Jens Spahn wants to abolish private health insurance

18/03/2012

Galten Union and FDP always as „Keeper of the private health insurance“, Slowly the followers are crumbling too. The CDU health expert Jens Spahn has spoken out in favor of the abolition of private health insurance. In this context, the renowned health economist Jürgen Wasem referred to the Dutch health care system. For a long time there exists a functioning health insurance system without differences between private and public health insurance.

Rising expenditure side of the PKV
For some time, the private health insurance in the criticism. Due to the demographic change and the associated rising health costs, insurers must constantly adjust their contributions. At the turn of the year alone, they had to accept collectively agreed premium increases of up to 60 percent. While the industry is always calm and aware of good results, the numbers speak a different language. Just over 12 years ago (2000), the insurance companies spent about 13.6 billion euros on medical and other services. In 2010, costs had nearly doubled to 22 billion.

The membership structure of the private funds has on average become older, because people live longer and longer. But that also means that insurers must spend more and more on innovative medical services. The advocated advantage of the private funds turns out to be a real cost driver: With the private health insurance, the insured can submit almost every bill of the doctor or the clinic.

Spartarife attract new members in the cost trap
In order to stimulate the new customer business, many private insurers have begun to lure the undecided with so-called low-price tariffs. With tariffs far below 100 euros, the customer is suggested that a health insurance could be gotten at a ridiculous price. The awakening usually comes after those concerned. Each year, the attracted customers experience price increases between 10 and 30 percent. Recently, it was on average even 40 percent, as industry experts calculated. Anyone who then wants to switch back to the statutory health insurance, has been unlucky in most cases, because a new admission to the SHI system is possible only in a few exceptions. Every year, more and more people are in debt because they can no longer pay the income-independent insurance premiums. To date, the number of debtors has risen to over 144,000. Because, however, since the health care reform is a compulsory insurance in Germany, the private funds may not terminate the defaulting payer. Together with the Federal Ministry of Health is now considered, a so-called „Non-payers fare“ which covers only one emergency care for € 100 per month. All these reasons call for timely action. On the part of the opposition already models like the „citizens insurance“ introduced into the discussion.

Cancellation of the separation between private health insurance and statutory health insurance required
The CDU health expert Jens Spahn had already demanded the abolition of quadruple rooms in hospitals last year. Now the politician advocates for a lifting of the separation between private and statutory health insurance. Because in the long run, there is no way around a reform, as he said. Spahn receives applause from the GKV. Doris Pfeiffer, the chairman of the association of statutory health insurances, said she was convinced that the model „the PKV is not sustainable in the long term.“ For years, the industry has been struggling with rising costs for doctors, medicines and clinics. „The increase in expenditure is higher than in the statutory health insurance“, explained Pfeiffer in an interview. However, private health insurance has no possibilities to control the expenditure side.

Ever higher retirement provisions
As healthcare costs increase, private insurers must build ever higher retirement provisions. In 2000 it was still 60 billion euros, today it is already 170 billion euros. In contrast, the number of fully insured members has increased only minimally.

Although Spahn pleads for the abolition of the artificial separation between SHI and PKV, but the diversity of the funds should be preserved in order to strengthen competition. In addition, it must be thought about fundamentally revise the structures. The statements meet with party friends in the CSU and the partner FDP on large rejection. Necessary reforms should not be prescribed, but left to the industry, as it was called by several CDU / CSU and FDP politicians.

Cash system of the Netherlands as a model for Germany
The health economist Prof. dr. Jürgen Wasem from the University of Duisburg-Essen is in favor of a uniform system based on the Dutch model. In the year 2006 there has been a major reform in Holland to reduce the differences between private and legal providers. Every Dutchman has to take out health insurance and health insurance companies are not allowed to deny citizens the basic health benefits. The financing of the model is fed by two different lines. Almost half of the insurance costs are paid by the citizens themselves. The amount is levied on a flat-rate basis, irrespective of the average annual income, age, gender and state of health. The other half is paid by the employer depending on the income. Self-employed, on the other hand, have to bear both costs themselves. If you have too little income, you get a government subsidy.

The central association of the private health insurance (PKV) rejects the Dutch cash scheme. According to the lobby representatives, there are many more restrictions in the range of services and rising costs due to the market concentration on a few providers. Nevertheless, there is a competition with the help of the insurance contributions and design of the service. In addition, insured persons have more options for supplementary insurance than was previously the case.

Implementation could cause problems
In Germany, there could be problems with the implementation of the model. While German clinics and doctors charge higher cost statements for private patients, this was never the case in Holland. In addition, the Dutch private providers had not accumulated a retirement provision, as is the case in Germany. The PKV criticizes the plans in this context sharply and speaks of „expropriation“ customers, if the retirement provisions have to be given up when the systems merge. Critics argue that the money could be spent before a reform for the insured or the private insured simply take the retirement provisions with.

But such models are still futuristic and are categorically rejected by the federal government. On the contrary, in order to keep the private health insurance system viable, new legislative changes are constantly being initiated in order to revive the new customer business again and again. The coalition agreement also stipulated that the separate system should continue to exist between the Union and the FDP. For the economist Prof. dr. Stefan Greß is already clear: In ten years, the PKV as we know it today, no longer exist. (Sb)

Read about:
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Health insurance: Non-payers cause losses
Private patients flee to the health insurance
Health insurance: additional contributions come again
Complaints about increase in PKV contributions
Health insurance: What will change in 2012?

Matthias Preisinger