How are caskets lowered
A cash injection for the health insurances from the well-filled box of the health fund (in the election year 2017), the question of the tastes and the real system problems
The financing of health insurances from the world of statutory health insurance (GKV) is a constant topic of health policy. In the earlier world, the rule was equal, i.e. half-way, financing through contributions from employees and employers - it should be pointed out that ultimately, from an economic point of view, employees always have to pay social security contributions alone, because the total personnel costs are always relevant for employers which also count the "employer" contributions. Now there has been a very significant change in terms of the distribution of the financial burdens, such as the fact that the employer's share has been frozen and the future costs and the resulting increase in contributions are to be raised solely by the insured via the "additional contributions", which are also between the health insurers Statutory health insurance world are different depending on the financial condition of the individual health insurance funds (cf. the blog post The insured persons in the statutory health insurance have to cope with it alone. The burden shift in the social insurance towards the employees gets an update from October 16, 2015).
This shift and the associated imbalance to the disadvantage of the insured in the GKV has already been criticized extensively in the past (cf. also on June 14, 2014 the article And through is it ... on the restructuring of health insurance financing and the associated decisions). But now we are - possibly - experiencing an escape from the consequences of this restructuring of the financing system in view of the upcoming federal elections in the coming year.
There is the general contribution rate of 14.6 percent, which employers and employees share equally, at least formally. The contribution income from the health insurance funds as well as subsidies from the federal budget flow into the health fund. According to a certain key, each health insurance company receives a monthly payment from it. If the resulting financial resources are insufficient, the fund must now charge its members an additional contribution in the sense of a percentage surcharge on the general contribution rate. On average, these are 1.1 percent this year.
However, an increase is predicted at the turn of 2017 and the average additional contribution rate could be 1.8 percent by 2018.
Now we have federal elections in the autumn of next year - and premium increases in the statutory health insurance, which also have to be borne exclusively by the members of the health insurance funds via the additional contribution mechanism, would not be a good fit. So how can you a) avoid this situation and b) then link it to the refugee issue?
But what does the question of a premium increase have to do with the refugee issue? This link must be seen in the context of the way in which the expenditure on health care for the people who have come to us as refugees is financed. That has already been basically dealt with in the article Expensive refugees and / or non-cost-covering Hartz IV recipients? Shallows in health insurance funding and the question of (no more) parity from February 21, 2016.
We have a dichotomy in the sense of a 15-month period: Refugees are treated on an equal footing with normal employees with regard to the social systems after a waiting period of 15 months (moreover, as asylum seekers, they are not entitled to the full benefit program of the statutory health insurance, but only to one slimmed down variant). If they do not have a job - which will initially apply to most refugees, they are entitled to unemployment benefit II (Hartz-IV). You also receive the full benefits of the statutory health insurance, the contributions to the respective fund are paid by the federal government.
For a long time now, predictions have been haunted by the public about what this could mean for the GKV: health insurance companies threaten a billion-dollar deficit, for example the headline of an article by Timot Szent-Ivanyi. The background to this assessment: »The amount of the contributions paid by the federal government does not even begin to cover the costs. The federal government currently pays around 90 euros a month for each Hartz IV recipient. There is still a lack of reliable figures as to how high the health costs caused by refugees actually are. However, there are initial empirical values from Hamburg that assume costs of 180 to 200 euros per month. This value is also considered realistic in North Rhine-Westphalia. It is assumed that many refugees are traumatized and require extensive medical treatment. "
Now more and more refugees are growing into the normal scope of protection provided by the statutory health insurance and a significant increase in Hartz IV recipients is expected from late summer of this year, when SGB II becomes responsible for the former refugees - and the flat rate takes effect. The federal government is now faced with the scenario that it will be confronted with the message in the election year 2017 that the health insurances will have to increase the additional contributions in order to finance the costs that are not covered (which, according to the allegation, is due to an insufficiently dimensioned flat rate for Hartz IV recipients are caused, but this is not clearly proven). In this scenario, one can imagine how this - whether true or not - can be exploited by the political forces that raise the mood against immigration.
Against this background, the “solution” signaled by such headings is understandable: Hermann Gröhe wants to access health funds for refugees or billions in cash infusions for the health insurance companies: »Experts predict the health insurance companies will increase additional contributions in the coming year, among other things because of the Refugees. That would be tricky in the election year. But now there is a huge injection of finance. "
And where should it come from? From tax funds? No, from the health fund, because it is well filled, also due to rising employment and wage increases in many industries.
“The fund's reserves should be reduced by a statutory regulation by 1.5 billion euros and the money should be made available to the coffers, said a ministry spokesman ... The health fund currently has reserves of around ten billion euros. In order to give the coffers more money from the reserve, the government has to change the law. With the now planned sum of 1.5 billion euros, according to the ministry, the coffers will be given specific support with the costs for refugees and the expenses for setting up a telematics infrastructure, which includes applications relating to the electronic health card. "
And what do the health insurance companies say? On the one hand, they want more: Representatives of the statutory health insurance are calling for the fund's reserves to be reduced beyond the planned EUR 1.5 billion. 6.5 billion euros and thus 35 percent of a monthly expenditure are sufficient as reserves, so that one could distribute 3.5 billion euros based on the 10 billion euros reserves.
On the other hand, there is obviously a queasy feeling about the connection with the (allegedly) "rising costs caused by the refugees", you can guess what a hot topic this is. This is how you have to understand the objection made by the Central Association of Statutory Health Insurance, which was reported under such headings:
»The Central Association of Statutory Health Insurance Funds (GKV) does not see any need to take additional billions from the health fund to provide medical care for refugees ... Pfeiffer said that at the moment it is not yet possible to reliably estimate how many asylum seekers receive unemployment benefit II ( ALG II) actually come into the statutory health insurance. “Separated from this, we have been criticizing for some time that the contributions for ALG II recipients are generally not cost-covering. If there is currently a real financial challenge for health insurers, it is certainly primarily the expensive reforms of the legislature and not the asylum seekers ”, added Pfeiffer,“ according to the article Health insurers do not want money for refugees.
Obviously one would like to give this (poisoned) part of the billion dollar gift back to politics.
And Doris Pfeiffer has openly named the actual system problem - it is not "the" refugees, but the point of criticism that has long been put forward by several sides that the flat rate for recipients of unemployment benefit II is set too low (for the background cf. the contribution Expensive refugees and / or non-cost-covering Hartz IV recipients? Shallows in health insurance financing and the question of (no more) parity from February 21, 2016).
And other relevant system problems of the financing of the statutory health insurance must be named here, then it becomes clear that the politically motivated, dangerous narrowing of the problem to "refugees" is completely under-complex and distracts from the points actually to be discussed:
In addition to the Underfunding of the flat rate for the many Hartz IV recipients are the Additional contributions due to the unilateral shifting of the burdens of future increases in expenditure to the paying members (tellingly, politics gets a whimper at the moment when this intended mechanism would take effect and a federal election is about to take place, which has more than one taste ). In addition, there is another one-sided burden, in this case the patient among the insured - the Co-payments. You have to make it clear at this point that co-payments mean nothing more than the (partial) withholding of a reimbursement by the health insurance company. And this is not about peanuts: co-payments of 3.6 billion euros are a major relief for the health insurance companies. And then there is that Federal grant from tax revenues to cover the “non-insurance benefits” in the statutory health insurance system, because on the one hand the amount set is much too low in the opinion of many critics and then in recent years it was used as a quarry for budget savings by the federal government. In addition, there is the narrowing of the financing basis, which can only be understood historically, on the one hand to income subject to social insurance contributions and, on the other hand, then also up to a contribution assessment limit, the exceeding of which means that every euro over it is not used for financing.
If you look at the system, that would also be Duality between GKV and PKV which leads to the fact that not infrequently "good risks" can say goodbye to the solidarity community of the statutory health insurance.
If you look at these keywords, it becomes clear that the actual financing debate in health insurance should be hung quite differently. And "the refugees" would only be a very small part of the package.
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