Health insurance companies achieve a plus of 1.1 billion euros in the first quarter of 2009
13.10.2009 15:19
First financial data of the GKV after the introduction of the health fund
The statutory health insurance companies received around 1.1 billion in the first three months after the introduction of the health fund. Euro surpluses were achieved, reports the Federal Ministry of Health (BMG). Revenues amounting to 42.5 billion euros were offset by expenses amounting to 41.4 billion euros. All types of cash registers were able to post surpluses in the first quarter and thus improve their financial situation and liquidity.
Solid financial foundation at the start of the health fund
The health insurance companies started on a solid financial basis with surpluses in the health fund. The fund and the new risk structure adjustment functioned as planned, the ministry announced. Through fixed monthly allocations, the funds receive calculation security and are not dependent on seasonal and economic fluctuations on the income side. So far, the health insurance companies have regularly had less income in the first three quarters than they needed to finance their expenses, which were only offset in the fourth quarter by contributions from one-off payments (“Christmas bonuses”), according to the BMG.
From the end of 2003 to the end of 2008, the health insurance companies were able to convert gross debts of 8.3 billion euros into financial reserves of over 4 billion euros thanks to the surplus development of the last five years.
In 2009 (not taking into account the agricultural health insurance funds (LKV), which do not participate in the health fund), the health insurance funds have allocations of around 167.6 billion euros available for the care of their insured persons. Compared to the preliminary expenditure volume for 2008, this is around €11 billion more.
Even with a cautious assessment, everything suggests that the health insurance companies will be able to cover 100 percent of their expenses in 2009 with the allocations from the health fund decided in October 2008, as provided for in the law, according to the BMG. This is also supported by the fact that, according to the BVA's assessment, only very few, generally smaller, funds will require an additional contribution, and just as few funds have announced that they will pay out a bonus.
The health fund paid out allocations totaling around EUR 41.5 billion to the health insurance funds for the first quarter. These disbursements were covered by corresponding health fund revenues from contributions and federal grants. The fund made use of the statutory option to advance monthly federal subsidy installments totaling around 1.26 billion euros.
Economic stimulus package creates protective shield for the GKV
With the economic stimulus package II, the parity-financed contribution rate in statutory health insurance will be reduced from 14.6 to 14.0 percent as of July 1, 2009. At the same time, the federal subsidy will be increased from EUR 4.0 billion to EUR 7.2 billion in the current year and will amount to EUR 11.8 billion in 2009. The contribution rate reduction is thus solidly counter-financed, according to the BMG.
The lower premium income that the health fund will incur due to the severe economic downturn and which the GKV estimators predicted at the end of April to be 2.9 billion euros for 2009 will be offset by a liquidity loan from the federal government to the health fund in the amount actually required.
According to the current economic assessment and considering the actual income trend, there is no reason to revise this number, the ministry states. The repayment obligation for a required loan would have been extended from 2010 to the end of 2011 with the second economic stimulus package. Precautions have therefore been taken to prevent the need for additional contributions to be collected this year due to the economic weakening of the income side. In the old system, in which the health insurance companies had to bear the income and expenditure risks during the year, the economic crisis would have long made nationwide contribution rate increases unavoidable - with the corresponding negative consequences for the purchasing power of the insured and the additional personnel costs of the companies.
Against this background, there is currently no reason to convert the loan into a grant. The BMG calls on the cash managers to live up to their responsibility for controlling the development of expenditure despite a significant increase in the financial resources available to them after the successful debt relief in recent years.
Expenditure growth in line with previous forecasts
In the first quarter of 2009, the health insurance funds' expenditure on benefits rose by 6.5 percent per insured person. Even though the rates of change in the first quarter are still based to a large extent on estimates from the health insurance companies, the increase was within the range that the Federal Insurance Office and the Federal Ministry of Health expected in the GKV estimators based on the entire year of 2009. The assessment of the National Association of Statutory Health Insurance Funds, which had previously assumed higher overall spending growth, has not yet been confirmed.
In the larger clinical areas, the development of expenditure has been very different:
The increase of 9.1 percent per insured person in expenditure on outpatient medical treatment shows that the fee situation for doctors will improve significantly again in 2009 with the fee reform. The additional expenses for medical screening examinations, which represent an increase of 11.7 per cent. H. are not yet included. Last year, contrary to what some officials always complained, the doctors received around 1.4 billion euros more from the health insurance companies than in 2007, based on a growth rate of 5 percent there was even an increase of 14.2 percent
Overall, the proportion of all GKV expenses that benefit statutory medical care (including the practice fee paid by the insured) increases to approximately 19 percent.
The increase in spending on inpatient care per insured person was 5.6 percent in the first quarter of 2009 and partly reflects the additional funds of approximately 3.5 billion euros that hospitals have received this year to improve financial and... working situation available. With the Hospital Financing Reform Act, from 2009 onwards, 50 percent of the collectively agreed personnel cost increases for 2008 and 2009 will be refinanced by the health insurance companies to the extent that they go beyond the basic wage development and are actually paid. To improve the situation in the nursing care sector in hospitals, additional financing options (90% share of the health insurance funds) are planned for up to 17,000 new nursing staff in the next few years. In addition, as part of the economic stimulus package II, hospitals will receive additional funds this year and next to finance urgently needed hospital investments. The federal government participates in additional investments by the federal states with 75%.
The increase in pharmaceutical expenditure (excluding vaccination costs) was 5.5 percent per insured person. In April 2009, according to the latest monthly data from the ABDA, there was a slight decline in spending of -0.8 percent. The development shows that the consistent use of savings opportunities through discount agreements between health insurance companies and drug manufacturers is urgently required as the year progresses. Effective control of pharmaceutical expenditure must not be limited to the successful exploitation of scope for price reductions in the fixed-price market. Rather, the possibility of cost-benefit assessment created by the GKV-WSG should also be used, especially for drugs with little additional therapeutic benefit, and thus unnecessary drug prescriptions should be avoided. Particularly in the area of new, highly effective and expensive drugs, it is important that they are used precisely and based on evidence. In the case of vaccinations, expenditure fell by around 5 percent after the high increases in 2007 and 2008.
After a long period of stability, the net administrative costs of the health insurance companies have increased by 4.4 percent per insured person in previous years, although with different developments for the individual types of insurance companies.