The Federal Government ends GKV Solidarprinzip

The Federal Government ends the solidarity principle of the GKV: social organizations and opposition criticize adopted health care reform

The governing coalition of CDU / CSU and FDP has passed the new financing law for the statutory health insurance funds (SHI). With the reform of the medicines law and the law for the financing of the legal health insurance Federal Health Minister Philipp Rösler (FDP) wants to save eleven billion euro: Social organizations and opposition criticized that reform package sharply: the proven since Bismarck basic principle of the equal and income-dependent financing of the legal health insurance (GKV) abandoned.

Employees bear all cost increases
As an introduction to the exit from the solidarity and equality financed statutory health insurance, the social associations evaluated in particular the new law to finance SHI. Since future contributions are to be made exclusively by the employees, whereas the employer's share was fixed, the insured persons bear all cost increases in the health system alone. Opposition and social organizations criticize that not only the principle of solidarity with the GKV is infiltrated, but from then on insured persons without employer support have to oppose the financial pressure of individual service providers.

Employer no longer in the boat
The president of the social association VdK Germany, Ulrike Mascher, criticized the freezing of the employer's contribution to 7.3 percent as a serious mistake. „Many illnesses have been proven to be caused by significant stress in the workplace, mainly due to stress and increasing work density. That's why employers should not be left out of the game when it comes to financing rising healthcare costs,“ explained the expert. The deputy leader of the SPD parliamentary group, Elke Fernerher formulated her criticism a little more striking: „The employers are no longer in the boat from today“.

Additional contributions endanger the social balance of the GKV
Also the additional contributions are in the social organizations and the opposition sharply in the criticism. Because the additional contributions are also borne exclusively by the insured and while they were previously allowed to be at most one percent of gross income, there will be no upper limit in the future. However, insured persons who spend more than two percent of their salary for additional contributions should be reimbursed by the Social Security Office for all contributions above two percent. This indirect „Introduction of unjustified capitation of unlimited amounts without adequate social compensation (leads) to a dangerous slide especially for low-income and pensioners“, said the deputy SPD parliamentary group leader, Elke Ferner. This would abolish the social equilibrium in the SHI, which was previously achieved automatically by percentage contributions, according to the opposition's criticism.

Three-class medicine by advance payment at the doctor
The principle of prepayment by the doctor enforced by the Federal Minister of Health is also viewed critically by the social organizations and the opposition. Ulrike Mascher emphasized that this was not a suitable way to make healthcare costs transparent. The opposition of the SPD goes in their criticism one step further. For example, Elke Ferner fears that a three-class medicine will be established by the advance payment from the doctor - „First Class for private insured, Business for patients with advance payment and wood class for the standard GKV insured persons.“ By the adoption of the principle of payment in kind in the direction of advance payment, low-income earners and pensioners would again particularly hard hit. On the basis of current reports, the opposition's criticism seems not entirely unjustified at this point, although the insured persons with private health insurance (PKV) base rates should be included as a fourth category. Because they are, according to media reports with their insurance protection even worse than the legally insured.

Fresh cell treatment for PKV
Another criticism of the adopted health care reform is for social organizations and opposition to strengthen the PKV at the expense of the SHI. „The private health insurance receives a fresh cell cure, which the GKV insured ultimately pay“, Elke Ferner explained. The simplified change for those earning good from the GKV to the private health insurance scheme, the ban on supplementary GKV insurance and the extension of the discount agreements for medicinal products to the private health insurance have significantly strengthened the competitive position of private health insurance - to the detriment of the legally insured. For example, the experts of the GKV-Spitzenverbands estimate that 400 million euros a year are lost to contributions from good earners simply because of the simplified bill of exchange. Conversely, private insurance companies would benefit from the discount agreements negotiated with the pharmaceutical manufacturers in the SHI and save around EUR 200 million a year.

Allegation: privatization and clientele policy
These are just a few examples of the comprehensive criticism that currently beats the Federal Health Minister Philipp Rösler (FDP) from ranks of social organizations and opposition. Elke Ferner further emphasized that the black-yellow federal government continued its privatization and clientel policy unrestrainedly and that people with low income were not only burdened materially one-sidedly but were discriminated against in the event of illness. Thus, the opponents of the reform also referred to the drug reorganization law (AMNOG), in which the pharmaceutical manufacturers were disproportionately favored in their view. Because in the original bill, some changes were made in favor of the pharmaceutical industry.

Criticism also on the drug reorganization law
For example, in the AMNOG pills for rare diseases were exempted from a benefit assessment up to a turnover of 50 million euros and approved drugs can no longer be excluded from the reimbursement by the statutory health insurance in the future. Although it should be noted that the preparations do not work well or worse. Only if the Institute for Quality and Efficiency in Health Care (IQWiG) can clearly prove that a preparation is ineffective or even has a worsening effect is an exclusion from reimbursement possible. However, as the IQWiG bases its findings mainly on the results of manufacturer studies and negative industry studies are rarely published, exclusion from reimbursement is very difficult to enforce. Thus, the statutory health insurance at this point the hands are tied to the pharmaceutical industry. Also, the pharmaceutical manufacturers in the introduction of a drug in the first year set the price and take place in the coming years on the basis of this entry price new price negotiations, not only by the social organizations and opposition criticized, because the manufacturers are probably the starting price as high as possible begin. (fp, 12.11.2010)

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