PKV study reveals severe performance weaknesses

Benefit claims in private health insurance often lower than in statutory health insurance

13/06/2012

According to a recent study, benefits in private health insurance (PHI) are often worse than in statutory health insurance (SHI). While the authors of the study speak of partial market failure, stressed the PKV Association Director Volker Leienbach opposite the radio station „MDR INFO“, that all tariffs of the private funds meet the minimum insurance protection.

The joint study by the Kieler Institut für Mikrodaten-Analyze (IfMDA) and the Frankfurt-based consulting firm PremiumCircle Deutschland GmbH reveals serious deficiencies in insurance coverage in numerous private health insurance tariffs. Not infrequently, the contracts contain existential exclusions in the event of illness, according to the results of the current study. Thus one of the advantages of private health insurance, which has always been mentioned, loses its validity. The benefit claims in the private health insurance are by no means more comprehensive than with the statutory health insurance.

80 percent of PKV tariff systems with lower insurance coverage than GKV
As part of the current study, the experts from the Kiel Institute for Microdata Analysis and the Frankfurt-based consulting firm PremiumCircle had examined 208 tariff systems from 32 private health insurances. Of the 1,567 combinations in terms of benefits and the different age and gender combinations, 250,000 different prices would result, report the study authors. In many private rates, according to the study, there were significant gaps in insurance coverage and the insured had lower benefit claims than in the GKV. In case of illness, existential services would often not be taken over. „As the distribution market is more frequently commission-oriented and less customer-oriented, the result is that PKV low-cost tariffs and other private health insurance plans with partly existential health benefits are sold“, This is the joint press release of PremiumCircle Deutschland GmbH and IfMDA. Citing the testimony of PremiumCircle CEO Claus-Dieter Gorr „The mirror“ Already in advance reported that more than 80 percent of the tariff systems of private health insurance afford less than the statutory health insurance. The authors of the study cited the lack of entitlement to follow-up treatment or psychotherapies as examples of the poorer status of private insured persons.

Commission excesses and market failure in private health insurance
According to the study is „a fundamental reorganization of the sales market and also the commissions“ at the PKV „essential“, if the "current undesirable developments are to be stopped". According to the experts, "the commissions for marketers would have to be reduced to four monthly premiums when concluding new contracts", "strictly regulating and monitoring" service premiums, and "upkeeping commissions of up to six percent being implemented". „The design of the service catalogs and the distribution market have become independent in the last 20 years due to a lack of political guard rails“, criticized Claus-Dieter Gorr. According to the statement of the PremiumCircle boss, the lack of government regulations has led to market failures in some areas of private health insurance. „For the correction, transparent mandatory information about the insured catalog of benefits as well as minimum criteria as a guideline for insurance conditions must be implemented and commission excesses terminated“, so Claus-Dieter Gorr on.

The GKV also reveals weaknesses
But not only the PKV reveals significant weaknesses in the current study, even the GKV can not convince comprehensively. Although the statutory health insurance with a probable surplus of 6.46 billion euros at the end of 2012 is relatively well, nevertheless, the „Generation conflict between pensioners and the employed has been significantly exacerbated since the mid-1960s“, the study authors report one of the problems with the GKV. Also be that „In its existing structure, SHI is a system without a sustainability perspective and with no self-healing powers, as health bureaucracy mechanisms have been expanded over the last 50 years“, complain the IfMDA and the consulting firm "PremiumCircle". Ultimately prevail in the GKV state failure, competition takes place only on paper. The head of the IfMDA, dr. Thomas Drabinski, stressed that the legislation „For decades the pensioner problem in the GKV displaced“ have „and burdened the ever-increasing burdens under the guise of the intergenerational contract with those in employment“ were. Here a fundamental reform of the GKV is indispensable, „so that the GKV solidarity principle does not become a structure-destroying element“, so the conclusion of Dr. Thomas Drabinski. (Fp)

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Picture: Gerd Altmann / Gerold Meiners