In Germany there is a major obstacle between a person and an appointment at a German specialist practice, it is called: How are you insured? Private or legal, it divides the country into privileged and less privileged patients, into “Please come this afternoon” and “Unfortunately we will have nothing until March 2023”. One of the central questions of the German health care system is whether it does not work better – and some, including the SPD, the Left and the Greens, want to remedy this problem with so-called citizen insurance: with insurance disease for everyone. But would it really be fairer?
The employer-funded Institute of the German Economy (IW) calculated what citizens’ insurance would actually mean for policyholders in Germany. The study, which the SZ has received, comes to the conclusion: in such a model, the burdens would be distributed differently than before, the current insured group could be prepared for lower contributions – but only for about six years. Then the cash contribution would increase again to today’s level.
In order to be able to calculate the costs of a joint insurance, the scientists first compared the disease risk of the two groups. It shows that between the ages of 20 and 70, those with private insurance incur significantly lower costs than those with legal insurance. In old age this is equalized. For the study, this was interpreted as an indication of the better health of private policyholders. Why is that? There are several possible explanations, explains Jochen Pimpertz, who studies health insurance and distribution issues at IW Cologne and is one of the study’s authors. One possibility is that, in particular, people with a good constitution generate a high income. Anyone struggling with their health could have a much harder time exceeding the income limit needed to purchase private health insurance. The other possibility would be for individuals to keep their insureds in good health for longer thanks to better services. “This question has not been scientifically clarified,” explains Pimpertz.
Contributions could drop by a point – but not forever
In fact, if everyone with private health insurance were to switch to statutory health insurance, more than the average number of seniors would be added, resulting in even higher costs. However, they would also bring in above-average income and, therefore, high contributions. This means that surpluses would be generated with the current contribution rate – the system does not provide for this, so the cash contribution would be reduced: by one percentage point, from the current 15.6% to 14.6%.
Anyone currently legally insured could therefore hope for financial relief from citizen insurance. However, this would only be temporary, says Pimpertz: “If all other framework conditions remain unchanged, so that costs continue to rise disproportionately, the old contribution level would be reached again after six years.”
Scientists also criticize the question of how the burdens would be distributed between the old and the young. Basically, the proportion of people who pay a “solidarity contribution”, that is to say who pay more than their current risk of illness, would initially remain almost constant at just under 40% when citizens’ insurance was introduced. . Due to demographic change – that is to say the aging of society – young people of working age are increasingly forced to continue to finance the compulsory health insurance system. “This problem exists now and there would always be citizen insurance,” Pimpertz said.
Can you solve this? The scientist suggests to cap the solidarity benefit from a certain point and to finance the rest by a capitalized insurance model. For policyholders, this would mean they would have additional costs – similar to the additional premium that is already owed by many health insurers – even if the premium rate does not increase. In the IW model, however, it would not be income-related surcharges, but insurance premiums. According to Pimpertz, this could lead to more competition on the supply side: Insurance companies could come up with models with which people could reduce their premiums, for example if they forgo the free choice of doctor and would always go to the family doctor first.
How are you insured? In any case, the issue seems to remain in the German healthcare system – one way or another.