“Historical pressure to act”: AOK publishes positions on the federal election
06.07.2021 16:54
The AOK federal association has published its position paper on the federal election on September 26th. Under the title "New Proximity" it summarizes the central demands of the AOK community for the health policy of the next federal government. Among other things, the AOK calls for stronger coordination and cooperation between actors beyond the sector boundaries of the healthcare system, a stronger focus on quality in care and a sustainable stabilization of statutory health insurance finances.
“We are currently under historical pressure to act,” says the chairman of the supervisory board of the AOK federal association for employers, Dr. Volker Hansen, on the occasion of the presentation of the position paper. “Until recently there were solid finances in statutory health and nursing care insurance, now we have poor finances.” These current problems were caused less by the pandemic than by the legislation of Health Minister Jens Spahn over the last four years. “Politicians have spent the contributors’ money with full hands,” said Hansen. At the same time, however, the grand coalition brought comparatively little benefit to the insured and patients. Important reforms in the hospital sector or in care have been left behind. “In addition, as a result of the health policy decisions of the last four years, we have seen an unprecedented weakening of the statutory health insurance’s ability to act and perform,” criticizes Hansen. The scope for self-administration has been massively restricted by state intervention. “These interventions from the current legislative period must be revised,” demands Knut Lambertin, alternating chairman of the supervisory board for the employee side. “In particular, it is necessary to restore the full budgetary and contribution rate autonomy of the statutory health insurance companies.” In addition, the social self-administration will work to ensure that the competition between health insurance companies to provide the best care for the insured is strengthened again.
“For us, new proximity doesn’t just mean physical proximity, quick access to healthcare or prompt treatment. Rather, the motto stands for the consistent and comprehensive orientation towards the needs of the insured," explains the CEO of the AOK Federal Association, Martin Litsch, the title of the position paper. The AOK's 30-page program for the federal election contains numerous concrete implementation proposals from all areas of health policy - including reform of emergency care, greater use of electronic patient files, reform of drug pricing and the further development of patient rights.
AOK proposes a “3+1 committee” to overcome sector boundaries
A central theme of the position paper is overcoming sector boundaries. In order to advance this, the AOK community is proposing the establishment of a “3+1 committee” at the state level. It should be staffed by representatives of the statutory health insurance associations, the state hospital associations and the health insurance companies - supplemented by representatives of the respective federal state as impartialists. This 3+1 committee is intended to take on the task of ensuring the provision, define the local supply requirements and, regardless of the sector, award corresponding supply contracts to local clinics, medical care centers and doctor's practices that are best suited for this - on the basis of regional contracts. “This model advances networking and at the same time creates the framework for the development of regional, interprofessional health centers,” emphasizes AOK board member Litsch. “If health insurance companies, state hospital companies, KVs and, last but not least, the states pull together, this creates new proximity and a constructive way of making decisions together that are more needs-based for good health care.”
Bundle inpatient services at suitable locations
In the hospital sector, the AOK demands that care for special, planned operations be better networked and controlled. “We are committed to ensuring that structural specifications and minimum quantities are expanded and implemented even better,” said Litsch. “The G-BA should create the appropriate framework conditions - and the federal states are then required to develop differentiated regional care orders for the clinics on this basis and in coordination with the 3+1 committee.” Inpatient services should be brought together at suitable locations . This regional bundling and concentration of specialized services also ensures the efficient deployment of staff and thus creates better working conditions for medical staff and nursing staff. “We are achieving new proximity by expanding outpatient services and regional health centers. This integrated approach creates better care than poorly utilized and poorly equipped hospitals,” says Litsch. The experience from the pandemic has shown that, especially in crisis situations, what is needed is not less, but more specialization and centralization of hospital services. “In this case, new proximity means that patients and patients do not end up in the next best hospital, but in the one that is closest to optimal care in terms of equipment, routine and know-how.”
Agreement on enormous financial challenges for health and nursing care insurance
The deputy chairman of the AOK Federal Association, Jens Martin Hoyer, commented on the financial perspective of statutory health and nursing care insurance: “There is currently great agreement among the statutory health and nursing care insurance companies that we will be faced with enormous financial challenges from next year.” The GKV's assets will be largely used up by the end of this year. The health fund's liquidity reserve also only has the statutory minimum reserve. “We are currently assuming an additional financial deficit of up to 17 billion euros in the statutory health insurance for 2022 alone, which would have to be paid for through the additional contributions,” said Hoyer. In purely mathematical terms, this means a jump in the average additional contribution rate from 1.3 to 2.4 percent. We therefore welcome the current federal government's intention to keep the additional statutory health insurance contribution at 1.3 percent. But with the increase in the federal subsidy by seven billion euros that has so far been promised for 2022, the threatened increase in the contribution rate can only be limited to 1.9 percent.
However, in order to achieve the goal of stabilizing the contribution rate for the coming year, the federal subsidy would have to be increased significantly again until the appraisal group's deliberations in October 2021. “If the incumbent government does not keep its promise, the incoming federal government must immediately bring order to the financial chaos in order to avoid increases in contributions,” said Hoyer.
According to Hoyer, things look similarly bleak financially for social long-term care insurance. Accordingly, the deficit in relation to the total volume there is similar to that in the GKV. “The most recent care reform, which has only brought minimal improvements for people in need of care, has further exacerbated the refinancing problem; this year there is already a risk of a deficit of 3.5 billion euros. “In the long term, federal funding for non-insurance benefits would have to be significantly increased,” said Hoyer.
Reliable federal contribution for non-insurance benefits and structural reforms that affect expenditure
In the future, the GKV also finally needs a reliable federal contribution on the income side that is dynamic based on wage developments for all non-insurance benefits. Overall, it is about a clear demarcation of financial responsibility between the statutory health insurance and the state and strengthening the contribution-financed system, Hoyer continued. This includes, above all, increasing the health insurance flat rates for ALG II recipients, which would reduce the GKV financial hole by around nine billion euros. The financial pressure in the statutory health insurance must also be reduced on the expenditure side. This requires, among other things, profound and sustainable structural reforms in the hospital sector and in drug pricing.
Further development of the RSA for the benefit of all insured persons
Hoyer is calling for further development in the interests of all insured persons when it comes to balancing the risk structure between health insurance companies. It is undisputed in science that so-called vulnerable groups have poorer health and a higher need for care. These included people with low income or a low pension, recipients of basic security, assistance with living expenses or ALG II, those in need of care and, in particular, people for whom several of these factors come together with chronic illnesses. “It is precisely for these insured persons that there is a need for systematic further development in the RSA because the allocations from the health fund do not cover the health insurance companies' expenses. This means that there are significant risk selection incentives, particularly at the expense of people and groups of people who are in need of social protection and are vulnerable. There is an urgent need for action by the coming federal government.”
The AOK community also sees a need for corrections to the regional equalization that has been introduced. In the current form of implementation, the so-called regional component is not in line with the objectives, creates negative economic incentives, particularly to the detriment of rural regions, and cements existing structures of over-, under- and inadequate supply even after exclusion of supply-side characteristics. The AOK community advocates targeted further development of the regional component so that these problematic effects can be prevented.
The position paper for download: www.aok-bv.de/positionen/bundetagswahl-2021/