Citizens’ insurance: what the alternative would bring financially – economy


In Germany there is a major hurdle between a person and an appointment in a German specialist practice, it is called: How are you insured? Private or legal, this divides the country into privileged and less privileged patients, into “Please come by this afternoon” and “Unfortunately we won’t have anything again until March 2023”. One of the central questions of the German health system is whether this really doesn’t work out better – and some, including the SPD, the Left and the Greens, want to remedy this problem with so-called citizens’ insurance: with health insurance for everyone. But would that really be fairer?

The employer-financed Institute of the German Economy (IW) has calculated what citizens’ insurance would actually mean for those insured in Germany. The study, which the SZ has received, comes to the conclusion: In such a model, the burdens would be distributed differently than before, the group of those currently insured could be prepared for lower contributions – but only for about six years. Then the cash contribution would rise again to today’s level.

In order to be able to calculate the costs of a joint insurance, the scientists first compared how high the disease risk of both groups is. It shows that between the ages of 20 and 70, those with private insurance incur significantly lower costs than those with statutory insurance. In old age, this is evened out. For the study, this was interpreted as an indication of the actually better health of the privately insured. Why is that? There are several possible explanations, says Jochen Pimpertz, who researches health insurance and distribution issues at the IW Cologne and is one of the authors of the study. One possibility is that especially people with a good constitution generate a high income. Anyone struggling with their health could have a much harder time getting over the income limit that is necessary for joining private health insurance. The other possibility would be for the private individuals to keep their insured persons healthy longer through better services. “This question has not been scientifically clarified,” says Pimpertz.

Contributions could drop by a whole point – but not forever

In fact, if all those insured with private health insurance were to switch to the statutory health insurance, an above-average number of older people would be added, which would cause correspondingly higher costs. However, they would also bring above-average incomes and consequently high contributions. This means that surpluses would be generated with the current contribution rate – the system does not provide for that, so the cash contribution would be reduced: by one percentage point from the current 15.6 to 14.6 percent.

Anyone who is currently legally insured could hope for financial relief from citizens’ insurance. However, this would only be temporary, says Pimpertz: “If all other framework conditions remain unchanged, so costs continue to grow disproportionately, the old contribution level would be reached again after six years.”

The scientists are also critical of the question of how the burdens would be distributed between old and young. Basically, the share of those people who pay a “solidarity contribution”, that is, who pay more than their current risk of illness arithmetically, would initially remain almost constant at almost 40 percent when citizens’ insurance is introduced. Due to demographic change – i.e. the aging of society – young people of working age are increasingly burdened to continue financing the statutory health insurance system. “This problem currently exists and it would continue to exist in a citizen insurance,” said Pimpertz.

Can you solve that? The scientist suggests capping the solidarity benefit from a certain point and financing the rest through a funded insurance model. For insured persons this would mean that they would have additional costs – similar to the additional contribution that is already due at many health insurers – even if the contribution rate does not increase. In the IW model, however, these would not be income-related surcharges, but insurance premiums. According to Pimpertz, this could lead to more competition on the supply side: Insurance companies could offer models with which people could reduce their premiums, for example if they forego a free choice of doctor and instead would always go to the family doctor first.

How are you insured? In any case, the question seems to remain in the German health system – one way or another.

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