Consumer advocates call for rapid PKV reform

Consumer advocates call for reform of private health insurance

30.03.2012

More and more private insured complain to the consumer centers on massively increased tariff contributions of private funds. Therefore, consumer advocates call for a far-reaching reform of the private insurance system. The Association of Private Health Insurance (PKV) beckons: The sample was "deeply dubious". The system has no problems.

Numerous complaints about contribution increases
More and more insured the private health insurance complain to consumer protection centers on sharply rising contributions. The Federal Association of Consumer Organizations (vzbv) therefore undertook an evaluation of a total of 144 complaints by insured members of the private funds, which were received by the central offices between December 2011 and March 2012. It showed that the contributions in individual tariffs increased on average by 23.9 percent. Some sufferers even had to accept premium increases of 60 percent. According to the experts, customers who were insured with a provider for a long time and older policyholders were particularly affected. „Our fears were far exceeded“, accounts Michael Wortberg, insurance expert of the consumer center Rhineland-Palatinate. By no means complained only 144 people. The study is only a sample, as consumer advocates emphasized. There were far more complaints received.

Especially older policyholders affected
With a few exceptions, the complaints include contracts that last longer than ten years and insured persons over the age of 45. „Customers report that they can no longer pay the retirement contributions“, says consumer advocate Wortberg. In one case, a 59-year-old woman paid a monthly fee of 1095 euros. Who then only receives a pension of 1200 euros, is lost. Because the contributions in the private health insurance are not as in the case of statutory health insurance after the income, but according to the completed tariff.

Exchange right is often subverted by providers
During the course of the study, it was shown that the right to switch from the insured to a lower-cost tariff is often undermined by health insurance. Only four of the 144 customers were able to switch to another tariff without any problems. "The opportunity to switch to cheaper rates within the PKV, must be easier," therefore demanded Gerd Billen, Board of the Federal Association of consumer advice centers. In addition, Billen criticized the PKV is missing „effective cost reductions“. As part of a reform in his opinion, the introduction of the principle of benefits in kind makes sense. The consumer complaints are "perhaps only the tip of the iceberg," said Billen.

Reform of the model of reimbursement required
Another requirement is a restructuring of reimbursement. According to the current model, the private patient must submit the invoice received from the doctor or clinic to his private fund. Instead, the billing between the service provider and the insurance company should be done, so Billen.

The supreme consumer advocate demanded more influence from politics. The Federal Minister of Health Daniel Bahr (FDP) should the various private health insurance rates „systematic and fast“ to get a check up. The aim should be consumer friendly reform. It had to be about "equalizing justice deficits and achieving efficiency gains" in order to stop the "contribution explosion" in private health insurance. „The consequences of a financial overburdening of consumers must not be socialized, but must be resolved within the PKV system“, also warned Billen. "It is unacceptable for private health insurance companies to charge more than for other patients," he said. Here, too, politics has to rethink what has happened so far.

PKV describes consumer protection study as frivolous
The Federal Association of Private Health Insurance (PKV) described the sample as „untrustworthy“. Volker Leienbach, CEO of the association responded that different and independent analysts had calculated an average increase in the contributions of the individual tariffs of only two percent. Each insured would have the right to switch to another tariff of the provider. This regulation is legally anchored. By contrast, statutory health insurance premiums have increased by 3.1 percent since 1997. The PKV by 3.3 percent. Thus, the contribution structure would be of similar magnitude. "The rising health costs affect both insurance systems alike," wrote Leyenbach in a statement. According to the association, around 8.9 million people in the private health insurance are fully insured. (Sb)

Also read:
DAK without additional contribution: AOK aggressive
Private funds are no longer acceptable
Termination model private health insurance (PKV)
Manipulations by PKV representatives

Picture: Gerd Altmann / Gerold Meiners