Health bonus

from Wikipedia, the free encyclopedia

The health premium is a concept to convert the financing of statutory health insurance in Germany to non-salary contributions and to reduce the employer's share in the financing or to increase the share of the insured in the financing. Such a concept was developed in 2004 by the CDU and CSU under the title solidarity health bonus , which is often referred to as a flat rate per capita . The FDP advocates a similar program, while the CSU has since moved away from the concept.

According to the coalition agreement of the governing coalition of CDU / CSU and FDP from 2009, the health insurance system should be converted to "income-independent employee contributions" (ie a flat rate) in the long term. As a first step towards a health premium, additional contributions independent of income were introduced without employers' contributions and the increase in the health insurance contribution was increasingly allocated to the employee contribution (employer contribution partly frozen).

The SPD , the Greens and the Left, on the other hand, favor the introduction of citizens' insurance, a uniform statutory health insurance for all people with their own income, with an extension of the assessment basis to all types of income. Citizen insurance would abolish the separation between statutory and private health insurance.

concept

CDU / CSU draft from 2004

The concept of the health premium provides for a fundamental restructuring of the financing of statutory health insurance. According to the compromise between CDU and CSU of 2004, the income-related contribution is to be replaced for employees by an income-independent contribution (“ premium ”) that is the same for all insured persons. Currently employers pay 7.3% and employees 8.2% of the gross wage as health insurance contributions. According to the concept of 2004, the employer's contribution will continue to be dependent on the gross wage of the insured person, but should be fixed at a reduced 6.5%. The non-income contribution is to be financed exclusively by the insured, thereby decoupling the company's wage costs from future increases in statutory health insurance contributions.

According to the 2004 draft, the health insurance companies should receive 169 euros per month for each adult insured person and 78 euros for each child. Low earners pay the same contribution as high earners. A tax-financed social compensation scheme for low-wage earners is planned, which limits contributions to 7% of taxable household income. The difference to the insured's premium is covered by the employer's contributions, while the social compensation comes from tax revenues. The children's co-insurance is financed proportionately from employer contributions and taxes.

Key issues paper of the Ministry of Health from 2010

According to the plans of the Federal Ministry of Health under Philipp Rösler (FDP), as a first step towards the health premium, every health insurance company should raise a premium for each insured person in addition to the insured person's contribution, which would amount to an average of around 30 euros. Similar to the CDU / CSU concept of 2004, family co- insurance should remain unchanged for the time being and social compensation should take place. The employer's contribution should remain frozen at 7.3 percent for the time being, regardless of cost increases.

Previous steps towards a health premium

Originally, the employer and employee contributed equally to the health insurance. Since July 1, 2005, the contribution burden was no longer divided equally between employees and employers. Employers only had to pay half of the general contribution rate, which had been reduced by 0.9 percentage points ( Section 249 (1) SGB V). The remaining part of the contribution had to be borne by the employees. As of January 1, 2011, employers contributed 7.3 percentage points and employees 8.2 percentage points. In 2015, the general contribution rate was set at 14.6%, half of which is borne by employers.

Since then, however, additional contributions independent of income can be levied for members of the statutory health insurance. These were paid by the insured person without an employer contribution. The amount of the additional contributions depends on the expected deficit of the statutory health insurance. Under certain conditions, a health insurance member is entitled to a tax-financed social compensation for the additional contribution according to § 242a .

Parity was restored on January 1, 2019, and employers now have to pay half of the additional contribution.

In contrast to financing, the division between employer and employee is not changed in the self-administration of the funds. This is also not planned in the health premium models.

criticism

It is often criticized that with the introduction of the health premium, the members of the statutory health insurance have to bear any cost increases without the involvement of the employer. That is why the German Federation of Trade Unions rejects a lump-sum contribution as socially unjust . Furthermore, it is viewed critically that the social equalization made necessary by the income-independent contribution is financed from tax revenues (instead of insurance contributions) and thus the state budget is burdened.

Implementation in other countries

A similar model of a health premium has existed in Switzerland since 1996 to finance compulsory health insurance (main article: Healthcare in Switzerland ) - but without the option of alternative to private insurance. The contributions are paid only by the insured without the employer's contribution and the amount is determined by the insurance companies in competition with each other. There is a state premium reduction for low-wage earners. In 2011 an adult Swiss pays an average of CHF 373.80  . , the equivalent of around 307 euros (as of January 2012) per month for this basic insurance. In addition, there is a general deductible (franchise) of CHF 300. In the year and above, a personal contribution of ten percent of the treatment costs up to a limit of 700 SFr. You can pay for an increase in the deductible to a maximum of CHF 2500. Grant premium discounts of up to 50%.

In the Netherlands, there has been an income-independent contribution to health insurance for employees since 2006. In contrast to the health premium, however, this head contribution is supplemented by an income-related contribution that is not limited by employers (the head contribution and the employer's share continue to contribute 50% to the financing) and es there are also elements of citizen insurance . When comparing the premiums across national borders, differences in the insurance companies' catalogs of benefits and in the general cost of living must be taken into account.

literature

Web links

credentials

  1. ↑ "Growth. Education. Cohesion. ” ( Memento from November 22, 2009 in the Internet Archive ) (PDF; 643 kB), coalition agreement between CDU, CSU and FDP. Page 86.
  2. ^ "Reform of the statutory health insurance - Solidarity health premium model", resolution C33 of the 18th party congress of the CDU in Germany. June 12, 2004.
  3. ↑ ( Page no longer available , search in web archives: The solidarity health premium model - questions and answers ) (PDF; 42 kB), CDU. November 19, 2004.@1@ 2Template: Toter Link / www.cdu.de
  4. ^ The health combination: stable, fair and transparent , Federal Ministry of Health, June 2010
  5. ^ Sheets for German and international politics: Röslers Prämienpoker , September 2010
  6. ↑ Frankfurter Rundschau: On the back of the patient , September 21, 2010
  7. ↑ head lump sum. (PDF; 435 kB) DGB Sozialpolitik aktuell, No. 2, February 22, 2010.
  8. ↑ Cantonal average premiums 2011/2012 for compulsory health insurance (with accident) ( Memento of October 24, 2011 in the Internet Archive ), Federal Office of Public Health .
  9. ↑ The compulsory health insurance briefly explained: You ask - we answer ( Memento of August 13, 2010 in the Internet Archive ), Federal Office of Public Health.