DBKK: “Lawsuit against financial equalization 2013 won”
04.07.2013 18:14
After the verdict was announced in the lawsuit before the State Social Court of North Rhine-Westphalia against the Morbi-RSA decision for 2013, the CEO of the DEUTSCHE BKK, Achim Kolanoski, explains: “It has now been confirmed by the court: the financial equalization of the health insurance companies contains a calculation error and must be corrected for 2013. This will strengthen the previously disadvantaged pension funds, which insure many older and sick people. The financing of health insurance companies will be fairer.”
For years, the DBKK had been demanding that the mathematical error in the health insurance companies' financial equalization (Morbi-RSA), confirmed by scientists, be corrected.
The Deutsche BKK has seen an urgent need to change the Morbi-RSA for years (see also MVF 02/12: “For targeted financial equalization of the health insurance funds”). In the opinion of the DBKK, financial equalization in the future must take precise account of the different morbidities in the insured structure and eliminate the distortion of competition. In its proposals, the “provider class” would like to achieve a simplification of the complicated (special) regulations and, according to the above-mentioned contribution by DBKK board chairman Achim Kolanoski, focuses first and foremost on eliminating the methodological error in the calculation of deceased persons.
From: MVF 02/12: “For targeted financial equalization of the coffers”
“It is undisputed that expenditure on medical services for sick insured people is highest in the last few months before death. It is also undisputed that health insurance companies with many chronically ill and older insured people report a higher death rate than health insurance companies with many young and healthy insured people. After two years of Morbi-RSA, it has now become clear that a methodological error in the calculation clearly creates a distortion of competition. The report of the scientific advisory board emphasizes that “there is a need for improvement with regard to the coverage rates of insured persons with diseases that are associated with high mortality and pronounced multimorbidity. For “healthy” and insured people, the low
Conversely, there are still noticeable surpluses due to the allocations from the health fund.” A calculation example from the Deutsche BKK shows the deficits. Around 12,000 insured people died at Deutsche BKK in 2009 and 2010. Almost 82 percent were over 70 years old. From this age onwards, the greatest discrepancy between the actual ones arises
Medical expenses and allocations from the fund. The coverage gap between actual costs and allocations from the health fund for deceased persons amounted to approximately 110 million euros in 2009
2010 approx. 122 million euros.
Among other things, this coverage gap is the result of a special regulation when calculating the surcharge amounts for the allocations in the Morbi-RSA. Contrary to the calculation methodology for all other insured persons who change health insurance companies during the year, the costs for insured persons whose membership ends due to death are not extrapolated to the year (annualized). While for insured people who
For example, switching to private health insurance or abroad or joining through birth in the course of a year, when calculating the Morbi-RSA surcharges, both the costs incurred and the
If insurance days are extrapolated over a year, the costs are not extrapolated for the deceased - and only there.
According to the experts, this unequal treatment means that “only half of the expenses of the deceased (…) are included in the calculation of the surcharges for the respective risk group.” Another problem is that the older the insured, the higher the average medical costs are . The difference between the actual treatment costs and the allocations from the health fund
increases as the insured person gets older. Within the large group of pensioners insured by Deutsche BKK, there were 17,000 people with a deficit in 2010 alone
of at least 10,000 euros per head. This means that 428 million euros are missing for this relatively small group of insured people alone.
Although the Morbi-RSA has fundamentally improved the consideration of morbidity compared to the old RSA since 2009, this does not apply to the coverage rates of deceased people. The report states that “the
The problem of the lack of annualization of the expenses of the deceased is also the reason why the excess coverage for those who switch funds and the underfunding for the deceased compared to the old RSA
including the risk pool." The calculated impact of this special regulation leads to an unacceptable distortion of competition to the detriment of the health insurance companies with many older,
chronically ill insured persons.
This is not about “extra surcharges for the deceased”, as is often deliberately erroneously put forward by those who benefit from the current regulation, but rather about equal treatment and eliminating a methodological error.
Below-average refinancing of the high medical costs of the deceased cannot be in the spirit of Morbi-RSA, which was introduced to, among other things, reduce the risk selection of health insurance companies. What justification is there for redistributing funds to accounts for healthy people at the expense of older, seriously ill insured people?”