New study criticizes SHI and PKV

Financial Terms

New study criticizes SHI and PKV

More than 60 experts from the healthcare and insurance industry have examined the German health insurance system. The scathing judgment of the study: The statutory health insurance is not prepared for the challenges of the future. Even with private health insurance, there are significant problems.

Problems of health insurance: health care in danger

Only a few weeks ago, Hermann Gröhe became Federal Minister of Health. Nevertheless, it is already clear that the next four years will bring him some challenges. Because the German health system has fundamental structural problems. Thus, it can no longer guarantee the long-term care of patients. This is also the result of an independent study by the consulting firm PremiumCircle, in which more than 60 experts, such as doctors, patient representatives, health insurance and insurance managers participated. The study, which will be published tomorrow, describes the statutory health insurance as a “disease management system”.

Problems of the statutory health insurance

In the study it is criticized that there is hardly any quality competition, especially with the legal insurance. This would also make the patient in the system more “means to an end”. Above all, the complexity of the system, lack of transparency and “confused financial flows” are criticized by the experts. Often it is also problematic that too many institutions are involved in the care of patients. This leads to problems, especially if it is not clear whether a treatment is to be assigned to the area of ​​statutory long-term care, accident or health insurance. If, for example, there is a need for care as a result of an accident, it must be clarified when the accident and when the long-term care insurance reimburses the costs of the care and whether the health insurance also covers the treatment. Especially when applying for benefits, it can lead to grueling waiting times for patients.

Financing of the statutory health insurance uncertain

Image result for federal ministry of health germanyIn the long term, the statutory health insurance is already facing problems. Through the so-called pay-as-you-go long-term financing problems arise in health insurance. Because fewer and fewer young working people have to finance their own health care, but also have to pay for the health costs of more and more older people. On the one hand, this means permanently higher health insurance contributions for legally insured persons. On the other hand, far less health benefits will likely be paid in the future. As part of the election campaign, for example, SPD and Greens have proposed the introduction of a solidary citizenship insurance to address this problem. With the grand coalition, however, this proposal is off the table. It remains to be seen what will change under Hermann Gröhe to meet this challenge.

Problems of private health insurance

Private health insurance must also be criticized in the study. According to PremiumCircle, there are significant performance deficits in the various tariffs. Since there are no legal standards in terms of the exact scope of services, the advertising of companies in some rates more services are suggested than actually offered. Unlike statutory health insurance, however, no private policies are currently planned for the private sector. It is true that in the context of the coalition negotiations there were efforts to make it possible to take over old-age provisions in the event of a change of provider within private health insurance, even for long-term insured persons. However, this reform proposal did not make it into the coalition agreement.