Private funds are no longer acceptable

Private health insurance is no longer socially acceptable

21/03/2012

The discussions about a possible abolition of the private health insurance (PKV) do not break off. Now also the boss of the top association of the legal health insurance companies (GKV), Dr. med. Doris Pfeiffer position. „I am convinced that the business model of private health insurance is not sustainable in the long term“, she explained in an interview with the „Rheinische Post“.

Private health insurance is an obsolete model
Pfeiffer criticized that the black-yellow federal government of the PKV increasingly supports, as the system would not work without numerous concessions. For example, the private health insurance benefits from the drug savings package that was actually installed for the statutory health insurance funds. Even privately insured persons would become increasingly skeptical: in 2011 alone, around 160,000 people would have switched from private to statutory health insurance. It would probably be much more if the change back through numerous legal hurdles would be closed to most PKV insured persons.

In the opinion of Pfeiffer, the business of private health insurance is an obsolete model that does itself. It is to be expected that in the future more and more companies will withdraw from the health insurance business, she told the newspaper. „PKV obviously has a problem of existence. I am convinced that the business model of private health insurance is not sustainable in the long term. PKV has been struggling for years with rising expenditure. The increase in expenditure is higher than in the statutory health insurance. The PKV has no tools to get that under control.“, she told RP.

Practice fee should be maintained
On the subject of practice fee explains the head of the GKV-Spitzenverbandes that this could only be abolished if there was an alternative source of income. The practice fee would be around two billion euros taken annually. One must think of the future, warns the association chairman. The surpluses from last year were not enough, despite billions. Before introducing the practice fee, experts hoped to reduce unnecessary medical visits. However, this was not achieved, as evaluations showed. Pfeiffer explains that the coalition agreement includes an order to reform the practice fee. In such a reform, however, care must be taken to maintain revenue. In addition, the control effect must be improved without deterring necessary visits to the doctor. So far, the coffers would have brought their own proposal. The policy has introduced the practice fee. Now she must also initiate appropriate reforms.

Pfeiffer refuses reduction of the federal subsidy
Finance Minister Schäuble (CDU) plans for the next year to withdraw the health fund two billion euros. Pfeiffer rejects this procedure: „We have been talking for many years about the need to be sustainable in social welfare systems. We have a so-called pension insurance. „sustainability reserve“, which is between 0.2 and 1.5 monthly expenses. If this one and a half months expenditure is exceeded, the contribution rate is lowered. Transferring to health insurance would mean that the reserves can total up to 22 billion euros. „Currently we are in the GKV with about 19 billion euros surplus. That is, I see no reason at all to talk about the distribution of funds or the reduction of federal subsidies.“ It considers a statutory reserve of statutory health insurance as in the case of pension insurance to make sense. However, their height still needs to be discussed.

Pfeiffer adds that the federal subsidy would finance non-insurance benefits, including sickness benefits, maternity protection and non-contributory co-insurance for children and spouses. However, since such expenditure was not reduced, she sees no reason to justify a reduction. In addition, there is an annual increase in expenditure of 3.5 percent. The revenue, however, would only increase by 1.5 percent. Overall, there is therefore a gap that can not be filled by the current exceptional situation.

In 2011, however, spending only increased by 2.5 percent. Pfeiffer explains the slight decrease in drug savings. In addition, the administrative costs of the health insurance funds have dropped and there has been a not too large increase in the costs for doctors and hospitals.

However, the public also has the impression that the health insurances save on benefits in order to avoid additional contributions. So it seems like fewer and fewer mother-father-child cures are approved. „We have been discussing this topic for years. The public perception, partly raised, that too many mother-father-child cures are rejected is not correct. The approval of such a cure requires medical justification. Frequently, however, only social, not health-related indications are provided“, explains the head of the umbrella association of the GKV. Only last year, the conditions for the approval of the cures were agreed by mutual agreement with organizations such as the Müttergenesungswerk in order to create more clarity.

Dutch cash register model for Germany?
The health economist Prof. dr. Jürgen Wasem from the University of Duisburg-Essen considers a uniform system based on the Dutch model also suitable in Germany. In 2006, there was a major reform in the Netherlands to harmonize private and public health insurance. There is a health insurance obligation for every Dutchman. For their part, the health insurance funds must not deny any citizen the basic health care services. The financing of the model is based on two different lines. Almost half of the cost of health insurance is borne by the citizen. 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 income. Self-employed, on the other hand, have to bear both shares themselves. For low-income insured, there are state subsidies.

The central association of the private health insurance (PKV) considers the Dutch cash scheme unsuitable. According to the lobbyists, the model would result in much more performance limitations and rising costs due to market concentration on a few suppliers. (Ag)

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