A health insurance (KV) is to hedge against the costs associated with a disease consequential risks failure of performance, care and medical treatment. The health insurance company fully or partially reimburses the insured person for the costs of treatment in the event of illness , maternity and often after accidents . In most industrialized countries there is the option of not only state but also private insurance against illness or care. There, private coverage appears alongside coverage in statutory health insurance systems or tax-financed national health services, which usually cover the entire population or the greater part of the population.
Health insurance is part of the health system and, in many countries, also part of the social security system. Membership in a health insurance company or a contract with a health insurance company is either legally mandatory ( compulsory insurance ) or voluntary ( individual insurance ).
In many countries, statutory and private health insurances exist side by side, and the role of private health insurers differs significantly. Private health insurance can have three different functions:
- Substitute: Part of the population can choose private health insurance as full insurance, or has no access to statutory health insurance cover - this substitutive function only exists in Germany and the USA
- Complementary: Services that are not or not fully covered in the public system can be privately insured - this is the function of private health insurance in all developed industrial countries (including Germany and the USA)
- In parallel: Individuals contribute to the financing of general health insurance coverage by paying contributions or taxes and, in parallel, can acquire the right to preferential treatment by paying private health insurance premiums - this is common in predominantly tax-financed health systems with capacity problems, such as in Great Britain and Canada .
Only in Germany is private health insurance a substitute for general statutory health insurance. In the United States - the only other country in which private health insurance has a substitutive function - only the needy, and especially needy people with children, may have access to tax-financed basic care. In the Netherlands until 2005 there was a coexistence of statutory and private health insurance, similar to that in Germany, although all workers with an income above an eligibility limit had to withdraw from social health insurance and fall back on full private health insurance; the two systems were integrated into a single system in 2006 through the health insurance reform . Only in Germany does the individual have to choose between health insurance in which everyone pays a solidarity contribution (solidarity principle in GKV) and health insurance in which everyone insures themselves against their own risk (equivalence principle in private health insurance, see also: solidarity principle vs. Equivalence principle ).
In some countries, benefits in kind are added in addition to financial benefits . Whether follow-up costs of accidents are covered by health insurance or instead by a special accident insurance is also country-specific.
The health insurance premium depends on the selected range of services or the income of the insured person.
In 2008 the legal basis for the establishment of European health insurances was created.
In Germany, it is a legal requirement for all residents to have coverage in the event of illness . The majority has the duty to register with a carrier of the statutory health insurance to be insured by income-related contribution. The rest is insurance-free with regard to the aforementioned social insurance , but still requires the statutory health insurance , either through private health insurance with a risk-based insurance premium or voluntary statutory health insurance .
As of 2016, the French supplementary insurance mutuelle santé individuelle , which was previously the basic insurance securité sociale , will be replaced by mutuelle entreprise (company health insurance). The new (compulsory) insurance divides the cost of insurance between the employer and employee in order to reduce private costs. The new insurance will be compulsory for every French worker and citizen. The insurance itself is not compulsory for the employee; however, it is mandatory for the employer to offer additional health insurance. The changes are accepted by many companies not only as a duty but as a recognition of the work of the employees; Others fear, however, that this change could later lead to the complete dissolution of the basic insurance (securité sociale).
As in Switzerland, a catalog of services is prescribed by law, and people must insure this risk with one of the recognized private insurance companies. Insurance companies must accept every person in the specified condition.
In Austria, coverage in the event of illness is only available for residents with a regular income and their families. This compulsory insurance is carried out completely and socially by corporations under public law , the health insurance companies. Social insurance is organized according to occupational classes. There are special regulations for the unemployed, pensioners and children. The health insurance premium is income-related. Employee benefits can be used as additional duly policy be protected ( private insurance ) .
In Switzerland, it is a legal requirement for all residents to have cover in the event of illness . The compulsory insurance exists for everyone within the framework of the legally prescribed minimum benefits of the mandatory health insurance and should not be confused with long-term care insurance . Here, there is a deductible per year, consisting of a fixed annual amount ( franchise , min. 300 Swiss francs ) and 10 percent of the franchise over rising costs ( deductible , max. 700 francs) is composed. Social health insurance is offered by health insurance companies and private insurance companies .
The insurance premium is not income-related and is not subsidized by the employer , but low-wage earners receive a subsidy from the respective canton , the so-called premium reduction . Premium reductions from the previous year must also be stated in the annual tax return. The amount of the premium can be freely set by the insurer, but then applies as a uniform premium for all insured persons of the same age group (children, young adults and adults) and premium region. Social health insurance must be offered to every person in addition to this standard premium ( mandatory contract ). Voluntary additional services can be insured as an additional policy (private insurance) .
United Kingdom of Great Britain and Northern Ireland
→ Main article: National Health Service
United States of America
- Fritz Dross et al .: health insurance. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 796 f.
- Stefan Greß, Simone Leiber, Maral Manouguian: Integration of private and statutory health insurance against the background of international experience. In: WSI Mitteilungen 7/2009. Hans Böckler Foundation, 2009, accessed on July 7, 2019 . Pp. 369-375.
- System of compulsory insurance (ASVG, GSVG, FSVG, BSVG). In: help.gv.at
- 100,000 Austrians have no insurance. In: Kurier , September 11, 2013
- health insurance. Public Employment Service Austria, accessed on April 4, 2015
- Uninsured people, In the waiting room of the destitute. In: zeit.de , March 29, 2012
- Self-insurance in health insurance. In: help.gv.at .