2023-06-06 17:48:23
BIn a work of the century, a few days are more or less irrelevant. The law passed in 2022 for the temporary stabilization of health insurance finances stipulated that the Ministry of Health should present a long-term solution “for stable, reliable and solidarity-based financing of statutory health insurance” (GKV) by the end of May 2023. According to the law, corresponding recommendations “for legal implementation”, which should also affect the expenditure side in particular, must also be made “with a view to the budget planning of the statutory health insurance companies”.
Health Minister Karl Lauterbach (SPD) did not quite meet the deadline – he could rightly refer to the unclear budget signals from Finance Minister Christian Lindner (FDP) – but at least a first proposal paper has now been coordinated by the government. This is still a long way from “legal implementation”, but the rescue operation is no longer as urgent as we thought.
Relaxation has set in for a long time
Because the health insurance companies are financially better off than feared. The outlook for 2024 is also not as miserable as previous deficits might have suggested. After the painstakingly balanced record minus of 17 billion euros in 2023, the National Association of Statutory Health Insurance Funds expects a shortfall of only 3.5 to 7 billion euros for 2024. “The funding gap in 2024 will be significantly smaller than in 2023,” notes Doris Pfeiffer, chair of the association.
The relaxation has set in for a long time. In the first quarter, the deficits in the two largest health insurance associations, the substitute funds and the general local health insurance funds, were only 38 and 57 million euros. According to the chairwoman of the AOK federal association, Carola Reimann, it is striking that expenditure has risen significantly more slowly than in the previous year, at 3.2 compared to 4.9 percent. This is surprising because during Corona many treatments and surgeries did not take place and were expected to be postponed. But that didn’t happen, as Reimann says: “Catch-up effects from the corona pandemic are still missing.”
Hardly any cuts on the expenditure side
This development had already become apparent in 2022, as an AOK study showed. At that time, the number of cases in hospitals fell by 15 percent compared to the pre-Covid year 2019. Since outpatient care is much cheaper than inpatient care, health insurance companies have to spend less money than originally thought. Income is also stable. Although Germany has slipped into recession, the number of employees subject to social security contributions for which statutory health insurance contributions are due continues to grow. In addition, there are comparatively sharp increases in wages, so that the head of the statutory health insurance association, Pfeiffer, can speak of a “positive income situation thanks to stable employment and high wage agreements”.
What Lauterbach will ultimately propose after consultation with the other departments for “sustainable statutory health insurance financing” is unclear. Neither increases in the contribution assessment and the compulsory insurance limit nor higher federal grants can be made with the FDP. Despite agreements to the contrary in the coalition agreement, Linder does not want to take over the non-insurance services either. And so the additional contributions will presumably be further increased; According to calculations by the GKV association, an increase of 0.2 to 0.4 percentage points would be necessary.
On the expenditure side, which the new law is supposed to focus on in particular, there are hardly any signs of cuts. There would be a lot of savings potential without the supply suffering, as Ferdinand Gerlach, former chairman of the Advisory Council on Health and Care, says. As examples, he cites greater outpatient treatment, more digitization and the reform of emergency care. Half of the patients in the emergency room are admitted as inpatients, much more than in other countries. “This also happens to fill the hospital beds for financial reasons,” says the medical professor. He welcomes the fact that the situation of the cash registers is currently a little more “relaxed” than feared: “If there is finally no need for hasty cost-cutting laws, we should use the time for real structural reforms.”
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