19.09.2013
Key Positions

Health Insurance

The internationally high standard of German health care is not least attributable to the dual statutory (SHI) and private health insurance (PHI) systems. Currently, a nationwide network of hospitals, family and specialist doctors and dentists is available to persons insured both privately and in persons insured both privately and in the statutory scheme. This is not least thanks to privately insured persons, who are willing to pay fees for special medical attention and services that go beyond the capped compensation from the statutory health insurance agencies.

The Christian liberal coalition has clearly identified itself with this duality of SHI and PHI. With the retraction of the three-year waiting period for employees, key impetus has been given for freedom of choice on the part of insured persons and for competition between the PHI and SHI systems. Thanks to the duality of SHI and PHI, the opportunity now exists to secure the long-term financing of the German health care system in light of demographic changes, without any breaks in the system. PHI aims at assuring more people and more services in an equitable fashion across the generations via a capital-backed health care system.

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Therefore, the introduction of the state-funded supplementary health care insurance at the start of this year provides the right, urgently needed support for the future. Over the long term, the support given to people in establishing supplementary private assurance will certainly prove to be a historical landmark. The funding is a shining example of a forward-looking policy, in line with generational needs, that does not close its eyes to demographic problems but instead seeks to head them off early on.

A private health insurance contract offers a permanent catalogue of benefits, which is continuously expanded in response to medical advances and whose scope cannot be restricted by government action. PHI secures sustainable financing for medical care by building up ageing reserves and, since its spending is not restricted by public budgets, it remains the driver for innovation and growth in the health care sector.

PHI’s dynamic commitment to quality assurance, advice regarding long-term care and prevention are further testimony to its active and formative role.

Over 90 per cent of private insurance customers feel that they are well or very well protected in case of illness, as demonstrated in several recent surveys by well-known institutions. In an effort to keep customer satisfaction high, PHI tries to improve the quality of care for its customers wherever possible: we try to negotiate binding quality standards with as many health care providers as possible for the benefit of all private insurance customers, as well as agreements with respect to quantities and prices.

Our Positions
Carefully further develop the duality of SHI and PHI
Thanks to its diversity and freedom of choices, the German health care system offers all people sound individual care. In contrast, what is entailed with the supposedly fair “unity system” can be observed in many neighboring European countries: long waiting lists for medicines, no free choice of doctors, separate structures of care for rich and poor. This is absolute two-class medicine.
Germany is envied worldwide for its sound health care provision. The system is so stable and efficient because it is based on the two pillars of statutory and private health insurance. This well-functioning system must be further developed in a careful and measured fashion, without negligently putting everything at risk through radical actions.
Cover more people and more benefits through the funded system
Taking demographic precautions through funded coverage ensures more sustainability and intergenerational equity for the social security system. This is good for all insured persons and strengthens the financial basis of the German health care system.
The pay-as-you-go financing system in statutory health insurance (SHI) must be limited to its core tasks in order to secure its ability to continue to function in the future, and more benefits should be transferred to the funded PHI system. This is particularly true for dental care, the sickness allowance and private accident insurance. Taking these services out of the SHI system could reduce contribution rates by almost 3 per cent.
More negotiating power for PHI
PHI’s concept to amend the schedule of medical fees is based on a contractual partnership with service providers: private health insurers will stand by their promise that good medical services will be adequately compensated. This is fair for service providers and good for service recipients as well. However, private health insurers need a clear legal framework for a general negotiating mandate which will allow insurers, in fair partnership with service providers, to have a greater influence on the quality, quantity and price of medical services.
Moving away from elective and supplementary tariffs in SHI
Because statutory health insurance funds are unable to calculate elective and supplementary rates in a risk-appropriate fashion, unlike in PHI, those rates are structurally underfinanced. In accordance with the provisions of insurance law, PHI guarantees that the contractually stipulated benefits will remain valid for the lifetime of the policyholder, while SHI elective benefits can be eliminated at any time if adequate financing is not available. As a result, there have already been cases in some health insurance funds in which insured persons paid contributions but never received any benefits because the service was cancelled before their illness. Moreover, such elective and supplementary benefits damage competition in a functioning private insurance market since they are offered by providers who are privileged under social law.