The health insurance deficit has systematic causes
02.12.2014 21:27
Statutory health insurance (GKV) will end the 2014 financial year with a loss for the first time in years. After just the first three quarters, the 131 health insurance companies reported a deficit of 740 million euros. Dr. commented on relevant media reports. Hans Unterhuber, CEO of Siemens company health insurance company SBK: “This negative development is no surprise and, unfortunately, has been predictable for a long time. The systematic distortions in the financing of statutory health insurance are now becoming clearly visible. Politicians are called upon to counteract any worsening of the imbalance in a timely manner.”
What is striking about the health insurance companies' financial results at the end of the third quarter of 2014 is not just the minus. Rather, the numbers show a clear imbalance between the types of health insurance. Guild, substitute and company health insurance companies show deficits. Only the General Local Health Insurance Funds (AOK) and the Knappschaft generate significant surpluses. “This clearly shows the consequences of cash equalization, which health insurance companies and health economists have been warning about for a long time,” explains Unterhuber.
The health insurance companies receive their income from the health fund, into which contributions with a volume of around 200 billion euros flow annually. The funds are allocated to the health insurance companies according to a specific distribution key, the morbidity-oriented risk structure equalization (Morbi - RSA). This financial compensation mechanism is intended to ensure solidarity between the individual health insurance funds and to compensate for the different differences in expenditure caused by morbidity and demographics. However, experts consider the Morbi - RSA to be in need of reform because it does not take into account additional factors such as regional supply costs. “This creates a lack of clarity, which means that many health insurance companies do not receive sufficient funds to cover the expenses for their insured persons,” criticizes SBK board member Unterhuber. Although the contributors to these health insurance companies make a solidarity contribution amounting to billions, the allocations from the fund are not enough to cover the care costs of the insured.
As part of the GKV – Financial Structure – and Quality – Further Development Act (GKV – FQWG), the legislature partially re-regulated the distribution of money from the health fund in June 2014. Among other things, the allocations for deceased insured persons were redefined. As a result of this regulation alone, the AOKen will in future receive an additional 330 million euros annually - at the expense of the other types of health insurance - even though it has already received more resources from the health fund than it needs to care for its insured people.
“The current design of the Morbi – RSA systematically favors individual types of health insurance funds and thus promotes an imbalance between the health funds. Whether a fund operates solidly and sustainably is completely irrelevant,” criticizes Unterhuber. “In the end, the ones who suffer are the insured. Ultimately, the affected health insurance companies have to compensate for their deficits through higher additional contributions,” said the fund manager. In an open letter to Federal Health Minister Hermann Gröhe in August, the SBK warned of the imbalance and called for a political debate. “Politicians are now asked to take action for the benefit of contributors and to make the Morbi – RSA balanced,” says Unterhuber.