Status: 08.09.2021 6:00 a.m.
The SPD, the Greens and the Left are calling for citizens’ insurance in their election manifestos. According to a survey by Infratest dimap, 69 percent of all respondents would speak out in favor of this model.
The vast majority of Germans are in favor of so-called citizens’ insurance, which would put the financing of statutory health insurance on a broader basis. That is the result of a representative survey for that ARD-Magazine monitor.
According to the survey by Infratest dimap 69 percent of those surveyed found the introduction of citizens’ insurance to be “good” or “very good”. It is surprising that even among the supporters of Union (68 percent) and FDP (62 percent), a clear majority of those surveyed support the introduction of citizens’ insurance. In their election manifestos, the SPD, the Greens and the Left are in favor of citizens’ insurance, while the Union and FDP are against it. You basically want to keep the previous system. The AfD does not comment specifically on this.
Financing statutory health insurance is one of the major challenges facing the next federal government. According to the DAK, the coffers are threatened with a minus of 27.3 billion euros by 2025. “If action is not taken now, the insured will face the historically largest increase in contributions as early as 2023,” said DAK boss Andreas Storm. The reasons are, among other things, the demographic development and higher costs of medical care. The need for reform is great – but the financing of the statutory health insurance has hardly played a role in the election campaign.
The concept of citizens’ insurance provides that all citizens pay a certain proportion of their income into a statutory health insurance and are entitled to the same benefits. Currently, the self-employed, higher earners and civil servants can take out private insurance instead. Income from investment income as well as rental and leasing would also be used to calculate the contribution.
The health economist Heinz Rothgang from the University of Bremen has calculated for the parliamentary group of the Left that the contribution rate of the statutory health insurance could decrease noticeably with the inclusion of further groups and the change of the contribution assessment ceiling. Citizens’ insurance would also bring more equity to the financing of the health system – even if further reforms would be necessary in the medium term. However, politicians think too much in terms of legislative periods instead of implementing fundamental reforms: “Ultimately, it is also a structural problem of our system that we do not think and plan for the long term, but rather that we move from one health reform to the next in the short term,” said Rothgang Monitor.
In a study, the Institut der deutschen Wirtschaft (IW) also came to the conclusion that the citizens’ insurance had a lower contribution rate: “However, the contribution burden of those with existing statutory health insurance would return to the original level within a few years,” the authors write. In addition, the aging of the insured community meant that the younger generation had to shoulder higher burdens. The experts agree that the next federal government must implement fundamental reforms in order to secure the financing of the health system.
Spending is increasing
For example, spending on pharmaceuticals has been increasing for years. The Techniker Krankenkasse (TK) recently stated that a few, but patent-protected, drugs in particular drove up prices. In 2019, the expenditure of the statutory health insurance for these preparations was therefore 21.6 billion euros and, according to TK, accounted for almost half of the pharmaceutical expenditure. “Patented drugs are one of the biggest cost drivers for statutory health insurance,” says Thomas Ballast, TK’s deputy chairman.
The financing gap in statutory health insurance has grown significantly recently. The federal government has decided for 2022 to increase the annual tax-financed federal subsidy for statutory health insurance by seven billion euros to 14.5 billion euros. In the opinion of the National Association of Statutory Health Insurance Funds, this is by no means sufficient: In order for the average additional contribution of 1.3 percent to be kept stable, a total of 14 billion euros in additional federal funds will be necessary in the next year, according to the association.