Practice fee

from Wikipedia, the free encyclopedia

The practice fee is the designation for an additional payment of 10 euros levied from 2004 to the end of 2012, which the insured in the statutory health insurance (GKV) in Germany when visiting a doctor, dentist or psychotherapist as well as in the emergency medical service ( medical emergency service or emergency room of a Hospital ) had to pay once a quarter (quarterly). It directly benefited the health insurance companies. It was therefore also called the cash desk fee . As of January 1, 2013, the practice fee no longer applies.

For the legal background and procedure for eligible patients, see co-payment obligation .

Legal basis

The basis of the survey was Section 28, Paragraph 4, Fifth Book of the Social Code (SGB V), amended by the Act on the Modernization of Statutory Health Insurance of November 14, 2003 and by the Law on Contracting Doctor Law (VÄndG) of December 22, 2006. The amount of the co-payment resulted from this Section 28 (4) sentence 1 SGB V i. V. m. Section 61 sentence 2 SGB V.

On June 25, 2009, the Federal Social Court ruled that the practice fee does not violate the constitutionally protected rights of patients.

aims

The objectives of the practice fee were:

  • Strengthening the personal responsibility of the insured for their health: In minor cases (e.g. scratches or bruises after a slight injury, mild cold), a doctor should not be consulted immediately.
  • Reduction of “self-referrals”: ​​Insured persons should only consult specialists with comparatively expensive treatments after referral by the family doctor, because the doctor is competent in selecting a suitable specialist colleague.
  • Short-term financial relief for statutory health insurance: The Federal Ministry of Health was hoping for additional income and savings of 2.6 billion euros annually.

Additional payment obligation

All insured persons of the statutory health insurance companies who were at least 18 years old and underwent outpatient medical, dental or psychotherapeutic treatment were obliged to pay additional payments, provided that this service was to be billed to the health insurance company.

Conversely, the practice fee was waived for self-payers , those with private insurance and other social insurers , as well as for civil servants , soldiers and those doing community service with salaried medical care . However , many employers deducted € 40 per year (equivalent to € 10 per quarter ) from the eligible expenses (so-called cost-containment lump sum ) for many employers , even if they only visited a doctor in one quarter. The Göttingen Administrative Court has declared the current state aid regulations to be incompatible with higher-ranking law. In contrast, a leap revision was filed with the Federal Administrative Court. According to the ruling of the Federal Administrative Court of April 30, 2009, civil servants also had to pay the practice fee by deducting it from aid payments.

Any form of statutory health check-ups were excluded from the co-payment. This also applied to a dental check-up, which also includes the removal of tartar (see below ). This regulation did not apply to civil servants of many employers, as their state aid rules do not provide for a distinction between preventive examinations and medical treatment on a specific occasion. Officials entitled to aid were therefore only reimbursed an invoice amount reduced by EUR 10 if they had taken advantage of a preventive medical check-up.

Furthermore, no practice fee was charged for visits to the doctor for which the statutory accident insurance (e.g. accidents at work, occupational diseases) or another statutory social insurance provider was the payer.

The practice fee was usually only due once a quarter at the first visit to the doctor. It was deducted from the amount to be paid by the federal state aid agencies and some state aid agencies (e.g. Bavaria). The rule that the fee was only incurred once a quarter was only introduced on July 1, 2004.

No additional fee was due for the further necessary doctor contacts in the same quarter with the same doctor. Doctor contacts with other doctors in the quarter concerned were free of charge if you could present a referral for this doctor and the doctor belonged to the same "treatment class". There were the following "treatment classes":

Referrals from doctor to dentist and vice versa from dentist to doctor crossed the "treatment classes"; so the practice fee had to be paid again. Another payment was made within a quarter even if patients went to a specialist without a referral slip.

In the worst case, a patient had to pay € 30 in practice fees in a quarter when he was at a doctor, a dentist or on an emergency service. This resulted in a maximum of unavoidable € 120 per year and person. The amount could also be higher if no transfers were used; then the fee had to be paid per quarter for each doctor's visit that was subject to a fee to another doctor.

Post Office Health Insurance Fund

Since January 1, 2004, the practice fee has also been due for members of the Post Office Health Insurance Fund. However, this was not settled by the Association of Statutory Health Insurance Physicians, but directly by the insured person in the statement either by paying the amount with a payment slip (member group A), by reducing the allowance (member group B) or reducing the reimbursement amount (all other member groups and member group A alternatively ).

Health care for Federal Railroad officials

Members of the health care of the Federal Railroad officials had to pay the practice fee since January 1, 2004. However, the practice fee was deducted from the reimbursement. However, if a member or a co-insured relative had reached the limit for their own contributions, the practice fee was no longer deducted.

Non-collection

Not surveyed for certain care models

Many health insurance companies offered an exemption from the practice fee or a reimbursement of the practice fee if certain care offers (e.g. disease management programs or family doctor models ) were taken. The regulations differed from one fund to the next. By the time the practice fee expired, the exemptions were abolished again at many health insurances, especially from 2010. The non-surveys led to a monetary restriction of the free choice of doctor, especially for low-income insured persons.

Failure to collect information from the doctor

All check-ups and some vaccinations were exempt from the practice fee; there was no practice fee for preventive examinations during pregnancy and for early cancer detection. However, these preventive examinations were only partially free of charge from the health insurance companies. If the doctor, for whom the practice fee has already been paid in the current quarter, is on vacation, the practice fee was also not charged to the representative on presentation of the receipt, which was then canceled with a stamp.

Failure to collect information from the dentist

In connection with the dental check-up (once every calendar half year), sensitivity tests , x-rays , creation of a periodontal screening index (PSI) and tartar removal (once every calendar year) were exempt from the practice fee.

Failure to collect for other reasons

For all services that are billed directly to the patient ("private medical services") no fee was charged. Have benefits from the respective statutory accident insurance been used , e.g. B. after an accident at work or school or when treating an occupational disease , there was no fee, since then no health insurance company was the cost bearer. If the pension insurance provider was a service provider, there was no fee either.

Exceptions

The practice fee did not have to be paid in the following constellations :

  • Exclusive use of pure preventive services or vaccinations (no referrals or advice were possible here)
  • Change of cash register in the current quarter
  • Evidence of exemption from co-payment
  • The practice fee is not charged, as a receipt for the practice fee already paid has been presented and canceled (cases under Section 18 (6) and (7) BMV-Ä or Section 21 (6) and (7) EKV)
  • No renewed charging of the practice fee in the case of cross-practice treatment by the same doctor or therapist
  • Reimbursement of costs in accordance with Section 13 SGB ​​V by the patient in the current quarter (proof of health insurance was available)
  • Representation in prenatal care

Unclear facts

  • The patient paid in the emergency service, then went to the same doctor in his practice for further treatment, no further payment of the practice fee.
  • In the emergency service, the patient met his family doctor, to whom he had already paid, but did not pay the practice fee again.
  • The patient was sent by the attending physician with a referral to the emergency medical service, so that z. B. a daily series of infusions can be continued on the weekend, the practice fee was due here. Transfers did not count in the emergency service (weekends, holidays, etc.).

Receipt

Bonus booklet (front)
Bonus booklet (back)

It was important to document the practice fee paid by collecting the receipts, especially because of the copayment and debit limits .

When visiting the dentist, the so-called bonus booklet still had to be stamped, as the receipts for practice fees paid to the dentist were not recognized as proof of prophylaxis and regular preventive care .

Special features and experiences

The first doctor contact in the quarter should therefore usually take place with the doctor with whom you received regular treatment. That doctor could then issue referrals for the other doctor visits necessary. A separate practice fee of € 10 per quarter was due for the visit to the dentist, unless it was a preventive medical check-up.

When visiting a psychological psychotherapist , however, a separate practice fee was not charged if a referral from a doctor from the same quarter was presented. If a psychological psychotherapist (PP) was first visited in a quarter, he would issue a receipt for the paid practice fee, since he could not issue a transfer. This receipt freed you from any further payment obligation for the first following doctor's visit in the same quarter.

Collection of the fee

The practice fee was initially collected by the statutory health insurance physicians; if the patient did not pay, the doctor could enter a special number for the health insurance bill so that the practice fee was not offset against the medical fee claim. Since the practice fee for the statutory health insurance physicians was not only seen as an additional bureaucratic burden, but also deterred patients from the treatment, it was rejected by a large number of doctors / dentists. Until recently, another group of doctors predicted an increase in the point value of their medical services remunerated according to the uniform assessment standard thanks to the decrease in the number of patients by around 8%. This hoped-for effect brought them, at least temporarily, to the side of the supporters of the practice fee in the statutory health insurance. In the meantime, however, the billing system has been converted to flat rates; there was no longer any point value.

Issuing the receipt for the practice fee and the additional cash in the practice, for which a safe often had to be purchased due to the risk of burglary and theft, was associated with additional work for the doctors . Particularly in atypical cases and irregular processes, a time-consuming need for clarification and explanation often arose. The demarcation to preventive examinations and treatments could not be solved in an administratively satisfactory manner. In the dental field, for example, at the start of the preventive medical check-up it was not at all clear whether a small caries would not be found that could be treated immediately and thus lead to a practice fee being due.

Cashing, acknowledging, documenting in the EDP and separately in a cash book for the tax advisor, evening cash counting, checking the cash register for differences in the cash fee amount, printing the list of all patients paid and manual comparison with the list from the Association of Statutory Health Insurance Physicians - the costs for this additional administrative work to be performed by the doctor's office was estimated at up to 5 euros per case.

A variant of the collection of the practice fee was blocked by the health insurers: direct offsetting against the health insurance contributions. The health insurers were aware of their members' visits to the doctor. It would therefore have been possible for each fund to add the practice fees to the subsequent billing of the fund contributions by each member according to the doctor's use, differentiated according to emergency service, dentist or doctor after a billed quarter.

Co-payment limit and upper debit limits

The practice fee could be limited under special financial conditions, if this was requested from the health insurance company, because there was an upper limit for all co-payments : the annual deductible of the insured (this included, in addition to the practice fee, co-payments for medicines , remedies and aids as well as the Co-payments for hospital stays) could not exceed 2% of gross income . For the chronically ill, the upper limit was 1%. Special consideration was given to families: Allowances for children and spouses reduced the underlying gross income.

However, if you have a low income, the health insurance companies set a minimum amount as a fictitious income, which is based on the social rate for the head of the household (currently € 4,488). No allowances for spouses and / or children have been deducted from this amount. In the case of low, no or negative income, the upper limit of the deductible was € 89.76 per year (chronic illness proven by the health insurance company 1% = € 44.80). The standard rate of social assistance that was used to calculate the minimum amount increased to € 347.00 on July 1, 2007. A fictitious load limit of € 4,164.00 (12 × € 347.00) applied in 2008 and a fictitious load limit of € 4,212.00 for 2009. For the chronically ill 1% each, for the non-chronically ill 2%.

Reminder and collection

A doctor could refuse treatment if the practice fee was not paid, unless there was a life-threatening emergency .

If the practice fee could not be collected immediately when visiting the doctor, the practice had two options for asking the patient to pay:

  1. If the patient was awake and responsive, he could sign a receipt, after which he undertook to transfer the practice fee within the legal period of ten days.
  2. If, for whatever reason, the patient was not asked to pay on site, the practice had to send him a written request for payment. Again, he was asked to transfer the fee within ten days.

If the patient allowed this deadline to pass, the dunning procedure was initiated by the Association of Statutory Health Insurance Physicians after a hearing letter with a deadline . If this did not induce the patient to pay either, the Association of Statutory Health Insurance Physicians had to try to collect the money under civil law.

It should be noted here, however, that due to the applicability of public law, there were no claims for reminder or damages in addition to a late-paid practice fee. In a procedure before the Düsseldorf Social Court, the action brought by a statutory health insurance association against a patient who had refused to pay the practice fee was only upheld with regard to this € 10, but the court denied the obligation to reimburse the reminder and postage fees. This led to the fact that at least the North Rhine National Association of Statutory Health Insurance Physicians recommended that doctors refuse treatment if it was not an emergency.

Insofar as a statutory health insurance association did not claim the fee in court, the health insurance company took over the collection of the fee itself, if necessary through a collection company.

Patients could file a complaint with the social court in the event of unjustified practice fees, e.g. due to incorrect facts relevant to the decision (e.g. charging of fees for preventive medical check-ups) . An objection procedure was not provided for by law ( Section 43b (2) sentence 7 SGB V).

Consequences of the practice fee

On April 1, 2005, the National Association of Statutory Health Insurance Physicians concluded from sample surveys for 2004 that there was a sustained decline in patient numbers. The samples showed a decrease of 8.7% overall. In particular ophthalmologists (−10.9%), surgeons (−11.6%), gynecologists (−15.1%), ear, nose and throat specialists (−11.1%), dermatologists (−17.5% ) and orthopedic surgeons (−11.3%) were visited less. However, the study left open whether the decline in the number of patients was mainly due to the absence of visits to the doctor in minor cases or to the absence of socially disadvantaged patients. According to a study, the number of outpatient doctor contacts of the statistically average member of the statutory health insurance in Germany was at 16.3 per year in the international comparison.

The basis for the following evaluations was data from 1.4 million GEK insured persons in 8.3 million treatment cases and with 27 million ICD diagnosis keys from 2004. 91% of the population had at least one doctor's contact. 2/3 of the German population see their family doctor at least once a year, on average every inhabitant 6.6 times a year. 10% of the insured have a high contact rate for outpatient services. They account for a good third of all doctor contacts and 43% of treatment costs. 1% of the insured cause approx. 13% of the costs. In Germany, there are an average of 16 outpatient doctor contacts. In an international comparison, this number is only at a similarly high level in Japan , Slovakia , the Czech Republic and Hungary .

In addition, the number of referrals has increased by over 40% since the introduction of the practice fee. Due to the practice fee, patients tended to go to the general practitioner first instead of going directly to the specialist. This corresponded to the control intention of the legislature, according to which the cheaper family doctor should first be visited and only from there should be referred to a specialist in justified cases. Specialists are usually paid higher. A family doctor can assess whether treatment by a specialist is necessary or whether he can carry out the treatment himself.

According to the doctors, the administrative expenses caused by the practice fee were 8.3 million working hours in 2004. A comparison with the time freed up, which results from the lower number of patients, is usually not made in the discussion, as this would put this number into perspective. However, this is not just about working hours. Because in the time that was filled with administrative tasks, no fee could be earned. There was no financial compensation for the additional administrative burden that benefits the health insurance companies alone.

With the direct payment of the practice fee, part of the medical fee went directly to the doctor and reduced the interest burden on the doctor, as the fee was only paid by the health insurance (after deduction of the practice fee) after the billing period.

There was no sustainable saving effect. The number of cases reported in 2007 was at the level of 2003, the year before the practice fee was introduced. In the four years since its introduction, the GKV practice fee has generated around € 6.5 billion in revenue. For 2008, the GEK study presented in 2010 even showed 18.1 doctor contacts per person with statutory health insurance, compared with 17.7 in 2007. It is believed that given the average number of 45 patients / day / doctor, i.e. H. Mathematically only 8 minutes of treatment per patient, too little time remains for the consultation and therefore several follow-up appointments are necessary. According to the Frankfurter Rundschau of January 20, 2010, the Union and the FDP "wanted to check the levy for its" control effect "in the near future. The fee was also a thorn in the side of doctors' associations because of the bureaucratic effort involved. "

The changes in patient flows, however, were not homogeneous across all income groups. As early as 2005, a study commissioned by the Bertelsmann Foundation noted that particularly low-income patients saved visits to the doctor; a negative effect that could have massive health effects in the future.

For the aid providers, the introduction of the practice fee was an occasion for cuts in their services, so that on the one hand there was a saving effect on the part of the public sector, but on the other hand the beneficiaries suffered financial disadvantages.

A study by the National Association of Statutory Health Insurance Dentists (KZBV) showed in November 2013 that the number of treatment cases at the dentist has risen sharply since the practice fee was abolished. The figures allow the conclusion that the 10-euro fee has deterred many legally insured persons from visiting the dentist. From the perspective of the KZBV, the results of the investigation make it clear that the practice fee was superfluous from the start.

Tax consideration

Paid practice fees cannot be claimed in the income tax return as a special expense (tax law) , but as an extraordinary burden and may have a tax-reducing effect. However, they only have a tax-reducing effect if a reasonable burden depending on the total amount of income , marital status and number of children is exceeded. Unless there are other extraordinary burdens, the practice fee alone will usually not have any tax effects. In July 2012, the Federal Fiscal Court also made it clear that those with statutory health insurance cannot claim the fee as a pension expense for tax purposes.

term

The popular term “practice fee” is legally incorrect, as fees can only be levied by public corporations . A formulation with “fee” or “special payment”, “deductible” or “additional payment” would be correct.

From the medical side, the naming of the practice fee is criticized by the politicians. Since this fee is passed on to the health insurance companies, it should correctly be called “health insurance fee”. The fee is only offset when the doctor's fees are paid out by the health insurance companies, so that there is no physical flow of money from the fee to the health insurers. The name practice fee suggests insufficiently informed patients that the fee represents an additional income in the practice.

Political development

For a long time there have been calls for the practice fee not to be charged per quarter but per doctor's visit in order to avoid false incentives. In order not to have to pay the practice fee for several quarters, insured persons waited for the beginning of a quarter before visiting the doctor and went to the doctor again towards the end of the quarter without any medical necessity.

This proposal was made, for example, in 2006 by the employers' associations of the then grand coalition; they repeated it in June 2010. The Federal Minister of Health rejected the request. It was raised in 2010 by the chairman of the CDU / CSU SME and Business Association , Josef Schlarmann . He pointed out that Germans go to the doctor on average eighteen times a year, while a Swede goes to the doctor less than three times a year. In Sweden there is a socially cushioned practice fee. The head of the Hartmannbund Doctors' Association , Kuno Winn (FDP), described patient co-payment per doctor's visit as correct, but the practice fee as too bureaucratic: "It would be better to have a percentage co-payment in the reimbursement system, of course, socially cushioned for chroniclers and poorer people."

The left-wing parliamentary group opposed the practice fee from the outset and presented a bill to abolish it in 2006. The parliamentary group criticized the fact that the "practice fee with advanced partial privatization of health risks particularly affects poorer population groups". She repeated the demand in 2009, when the Bundestag applied for the abolition of all other co-payments in addition to the practice fee, and in March 2012, when, according to the statements of FDP politicians against the practice fee, there was an arithmetical majority in the Bundestag for its abolition. The FDP and the Union then prevented the health committee from voting on the application.

The SPD politician Karl Lauterbach said that a practice fee for every visit to the doctor hit the wrong people, “namely old and poor people” . Lauterbach advocates better prevention and care by general practitioners in order to “rule out unnecessary treatments” .

When the good financial situation of many statutory health insurances became known in March 2012 - they achieved a surplus of 13.8 billion euros (after 2.7 billion euros in 2010), the FDP took this as an opportunity to abolish those that were already little supported by it To request practice fee.

On March 9, 2012, SPD general secretary Andrea Nahles also declared that her party was in favor of abolishing the practice fee because the hoped-for control effect had "fizzled out". New co-payments are not planned. On March 28, the SPD parliamentary group published a motion with the same goal. The SPD of North Rhine-Westphalia has included the call for the practice fee to be abolished in its election program.

The NGO Campact started a signature campaign in October 2012 to abolish the practice fee.

Abolition of the practice fee

On November 9, 2012, the Bundestag decided with the votes of all parliamentary groups to abolish the practice fee as of January 1, 2013. The goal of the practice fee, to reduce the number of doctor visits and to structure the use of contract doctors, had not been achieved. However, low-wage earners would be deterred from necessary visits to the doctor. The practice fee is a one-sided burden on the patient, the additional income is low and only covers just under one percent of the expenses of the statutory health insurance. The practice fee, however, causes useless bureaucracy.

Base tariff

The statutory provisions on the basic tariff in the Insurance Supervision Act (VAG) and in the Insurance Contract Act (VVG) never contained an express regulation, even before the practice fee was abolished by the Assistance Care Requirements Act, according to which the practice fee is also to be levied in the area of ​​the basic tariff. However, since section 12 (1a) sentence 1 VAG generally regulates that the contractual services of the basic tariff must be comparable in type, scope and amount to the services according to the third chapter of SGB V to which there is a claim, the PKV has in their General Insurance Conditions for the basic tariff to the extent that a parallel to the practice fee has been incorporated, which corresponds to the matter - now repealed by the Assistenzpflegebedarfsgesetz - in Section 28 Paragraph 4 SGB V (in particular its sentence 3 for reimbursement cases) and provides that for each first use of a (dental) medical service provider in the quarter that is not based on a referral from the same quarter, an additional payment of 10 euros is deducted from the reimbursement amount, which PKV will therefore comply with in the event of reimbursement (see section Tariff BT, A. 3. der General model insurance conditions 2009 for the basic tariff, MB / BT 2009).

Since there were no statutory provisions in the VAG and VVG specifically tailored to the practice fee, there were no repeals or changes in this regard in the course of the Assistant Care Requirement Act, which abolished the practice fee. The general insurance conditions for the basic tariff, on the other hand, are currently still in force in the version mentioned, so that a corresponding retention of 10 euros per quarter can still be made in the basic tariff. There should also be no obligation on the part of the private health insurer to change the insurance conditions after the repeal of Section 28 (4) SGB V so that the relevant retention of 10 euros per quarter will no longer be made in the future, because the basic tariff must be in accordance with the - unchanged - Section 12 (1a) sentence 1 SGB V can only be “comparable” with the statutory health insurance benefits, which does not necessarily mean that it has to be absolutely identical.

However, the PKV has done the same as the statutory health insurance and abolished the practice fee.

See also

literature

  • Andreas Hövelberndt: The charging of the practice fee by the providers of statutory medical services - reform approach or unconstitutional bureaucratic burden? In: Verwaltungsrundschau. Journal for Administration in Practice and Science , Vol. 49 (2004), pp. 329 ff. ISSN  0342-5592

Web links

Individual evidence

  1. ↑ through the repeal of Section 28 (4) SGB V by Art. 1 No. 2 of the Act regulating the need for assistance in inpatient care or rehabilitation facilities of December 20, 2012, Federal Law Gazette I p. 2789
  2. ↑ BSG, judgment of June 25, 2009 , Az. B 3 KR 3/08 R, full text.
  3. ^ Administrative Court of Göttingen, judgment of February 26, 2008 ( Memento of February 12, 2010 in the Internet Archive ), Az. 3 A 277/07.
  4. ↑ Press release No. 26/2009 of the Federal Administrative Court of April 30, 2009 ( Memento of July 21, 2012 in the web archive archive.today ) (last accessed on October 1, 2009)
  5. ↑ National Association of Statutory Health Insurance Physicians : Questions and answers on the practice fee ( Memento from August 2, 2010 in the Internet Archive ) (last accessed on June 11, 2010)
  6. ^ SG Düsseldorf, judgment of March 22, 2005 , Az. S 34 KR 269/04. Full text.
  7. ↑ a b National Association of Statutory Health Insurance Physicians: Klartext edition from April 1, 2005 ( Memento from September 27, 2007 in the Internet Archive )
  8. ↑ Doctors newspaper, 10./11. November 2006, p. 1: 16 doctor visits per year
  9. ↑ Quoted from: Medical Tribune No. 47, November 24, 2006, p. 27.
  10. ^ National Association of Statutory Health Insurance Physicians : Press releases 2006 ( Memento of May 3, 2006 in the Internet Archive )
  11. ↑ 6.5 billion € for the practice fee, Ärzte Zeitung, December 11, 2007, p. 4.
  12. ↑ See a doctor 18 times a year, SZ, January 20, 2010, p. 15.
  13. ↑ Frankfurter Rundschau , January 20, 2010, p. 1.
  14. ↑ Bertelsmann Stiftung: Practice fee shows undesirable side effects
  15. ↑ After the practice fee has expired, Germans go to the dentist more often ( memento from November 7, 2013 in the Internet Archive ), last accessed on November 22, 2013.
  16. ↑ Discussion of the verdict in the social security law portal SV-LEX ( memento of October 13, 2012 in the Internet Archive ), accessed on September 7, 2012.
  17. ↑ Employers demand a five-euro fee per doctor's visit , spiegel.de of May 8, 2006
  18. ↑ Employers demand five euros per visit to the doctor , spiegel.de of June 4, 2010
  19. ↑ http://dip21.bundestag.de/dip21/btd/16/004/1600451.pdf
  20. ↑ http://dip21.bundestag.de/dip21/btd/17/002/1700241.pdf
  21. ↑ http://dip21.bundestag.de/dip21/btd/17/090/1709031.pdf
  22. ↑ Archived copy ( Memento of July 8, 2014 in the Internet Archive )
  23. ↑ https://web.archive.org/web/20140715180739/http://www.n24.de/n24/Nachrichten/Ppolitik/d/1042814/regierung-lehnt-praxisgebuehr-bei-jedem-arztbesuch-ab.html n24.de July 16, 2010
  24. ↑ Record income - Germany's boom economy fills social coffers , spiegel.de
  25. ^ The greedy state , spiegel.de
  26. ↑ Archived copy ( Memento from May 16, 2012 in the Internet Archive )
  27. ↑ http://dipbt.bundestag.de/dip21.web/search/find_without_search_list.do?selId=43736&method=select&offset=0&nummer=100&sort=1&direction=asc}
  28. ↑ Archived copy ( Memento from April 18, 2012 in the Internet Archive )
  29. ↑ campact.de ( Memento from December 17, 2012 in the web archive archive.today )
  30. ↑ Minutes of the plenary session 17/205, pp. 25033, 25047
  31. ↑ Practice fee will be abolished on January 1st.
  32. ↑ Resolution recommendation and report of the Bundestag Committee on Health, Bundestag printed matter 17/11396 of November 7, 2012
  33. ↑ General Insurance Conditions 2009 for the basic tariff (MB / BT 2009) §§ 1 - 18, BT tariff (PDF; 589 kB) Association of Private Health Insurance eV (as of January 1, 2012). Archived from the original on February 1, 2013. Retrieved October 12, 2012.