Health insurance in Germany

from Wikipedia, the free encyclopedia

The health insurance in Germany is

A health insurance reimburses the insured fully or partially the cost of therapies for disease , maternity and often by accident . It is a two-part part of the health system in the German social security system .

history

Germany has the world's oldest social health insurance system, which was founded by Otto von Bismarck . The Health Insurance Act (KVG) of June 15, 1883, which he enacted , comprised mandatory health insurance for all workers with an annual income of less than 2000 marks, pension and disability insurance and accident insurance, but - in contrast to the Health Insurance Act of January 1, 1914 - no dental treatment as a health insurance. Bismarck propagated three key principles of government responsibility: solidarity (the government is responsible for those who need help), subsidiarity (minimum administrative effort and political influence) and corporatism (democratically elected representation at the government level of those involved in the health system).

Compulsory health coverage was originally limited to lower-income workers and certain government employees, but has been expanded over time to cover a large proportion of the population. The system was decentralized. Doctors practicing privately with ambulance services supplemented the non-profit hospitals for inpatient stays. The insurance was funded by a mixture of employer and employee contributions and government grants. Since the contributions were staggered according to income, people with higher incomes chose private health insurance instead, which staggered the contributions according to their state of health and not according to income.

Since certain sections of the population, such as the self-employed, civil servants and clergy, could not insure themselves with these funds, they founded corresponding institutions on a private basis, which since the Reich Law on Private Insurance Companies of 1901 have been subject to the Imperial Supervisory Office for Private Insurance and the dual system of statutory and private health insurance justified.

General compulsory health insurance

With the SHI Competition Enhancement Act (GKV-WSG) of 26 March 2007 was April 1, 2007 in public health insurance for those individuals compulsory insurance introduced that no other entitlement to health care coverage (like aid , medical care , private health insurance ) and most recently had statutory health insurance or were not previously covered by statutory or private health insurance ( Section 5 (1) No. 13 SGB V), unless you are self- employed ( Section 5 (5) SGB V), for other reasons in accordance with Section 6 (1) and (2) SGB V exempt from insurance or would have belonged to these groups of people who were not subject to compulsory insurance when exercising their professional activity in Germany (“ mandatory insurance ”). For health insurers of statutory health insurance, there is an obligation to accept persons assigned to statutory health insurance.

Since January 1, 2009, according to § 193 III VVG, there has been a general health insurance obligation , according to which all persons residing in Germany must take out medical insurance with a health insurer approved in Germany . The only exceptions are people who

  • are insured or subject to compulsory insurance in statutory health insurance,
  • Have the right to medical care, assistance or comparable claims,
  • Are entitled to benefits under the Asylum Seekers Benefits Act , or who
  • Recipients of ongoing benefits according to the third, fourth, sixth and seventh chapters of Book Twelve of the Social Security Code.

For private health insurance companies, there is an obligation to accept people who are not legally insured in the basic tariff .

People without health insurance

According to the Federal Statistical Office, 188,000 German citizens (uninsured self-employed not recorded) were without any health insurance in 2003. The number had thus doubled since 1995. For 2005 an increase to 300,000 uninsured residents was expected. For 2007 the number was estimated at 400,000. One reason for this is often given as economic pressure, i.e. not taking out health insurance as a cost-saving measure. Until December 31, 2008, there was the group of high-earning, deliberately uninsured. They were insurance-free and bore their own risk of illness and saved the costs of administration and redistribution components of health insurance.

With the introduction of compulsory insurance without exception, the number of people not insured fell.

Since April 1, 2007, all those who were previously legally insured have been obliged to take out health insurance again. Since 2009 this has also applied to formerly privately insured persons.

In the period without health insurance cover, contribution debts accrue, which at least partially have to be paid in arrears without receiving benefits for this period. The additional payment is calculated from the day on which insurance would actually have been required. For people who have to take out statutory health insurance, i.e. retrospectively from April 1, 2007, for returnees to private health insurance from January 1, 2009.

According to Section 174 (5) SGB ​​V , former statutory insured persons must return to the health insurance company of which they were last a member. The former insured person must be re-admitted there regardless of their state of health.

Every private health insurer is obliged to include people without insurance coverage in the so-called basic tariff . Its services roughly correspond to the current scope of statutory health insurance. Insurers can ask about the health of the applicant, but they are not allowed to ask for or refuse surcharges. Only people in good health have the option of joining a regular, open tariff from a private health insurance company.

The contribution for the basic tariff is capped at the statutory maximum contribution in the GKV plus the average additional contribution ( § 193 Abs. 5 VVG ). People in need within the meaning of the Social Security Code only pay half of the contribution. If necessary, a subsidy can also be paid from the job center or the responsible social welfare office.

In 2011, according to the Federal Statistical Office, only 137,000 people in Germany were not insured and had no other right to health care. This corresponded to a share of less than 0.2% of the total population. The remaining uninsured do not make themselves a criminal offense, but fall into a debt trap in that they have to pay all outstanding contributions since the existence of the compulsory insurance plus a late payment surcharge of 60 percent on top.

Asylum seekers and welfare recipients

In the public health insurance is a possibility that has existed since 2004 asylum seekers and welfare recipients , a health insurance card or electronic health card for billing purposes of a health insurance company will receive. The benefits are paid from tax and not from insurance funds ( § 264 SGB ​​V).

Tax treatment of contributions

Contributions to health insurance are fully deductible as a special expense insofar as they are required to achieve a level of care equivalent to social assistance as determined by Book Twelve of the Social Code . For contributions to the statutory health insurance, these are the contributions stipulated in the third title of the first section of the eighth chapter of the fifth book of the Social Security Code or the sixth section of the second law on the health insurance of farmers. If health insurance contributions give rise to an entitlement to sickness benefit or a claim to a benefit that is granted instead of sickness benefit, the respective contribution must be reduced by 4 percent. In the case of private health insurance, those contribution shares are deductible as a special expense that are attributable to those contractual benefits which, with the exception of the contribution shares attributable to sickness benefit, are comparable in type, scope and amount with those benefits according to the third chapter of the fifth book of the Social Security Code to which there is a claim. Contributions for additional services (e.g. single or double rooms in a hospital ) are not tax-deductible.

criticism

The German insurance system with the coexistence of private and statutory health insurance is considered by critics such as Karl Lauterbach to be lacking in solidarity. As a system of two-class medicine , it is part of a two -class state alongside education policy, pension insurance and care. The health system therefore not only achieves disappointing treatment results in international comparison, but it is also unfairly financed. The private health insurances would be subsidized in 2011 with 9.7 billion euros from the statutory insured, this would bring the doctors 22% of their income, from which only a few doctors would benefit.

A representative study published in 2020 by the independent Berlin research and advisory institute for infrastructure and health issues ( IGES Institute ) on behalf of the non-profit Bertelsmann Foundation criticized the fact that in Europe only Germany offers a dual system of statutory and private health insurance. According to the experts, the contributions could decrease significantly if all citizens were covered by statutory health insurance. This assessment met with criticism from the German Medical Association and representatives of private health insurance.

Trivia

German health insurance companies are said to have poor payment practices in Austria. There, German insurance companies were the front runners in 2013 with outstanding balances of EUR 118 million, ahead of Romania with EUR 12 million and Italy with EUR 8 million. On the other hand, Austria's health insurance companies have debts of 144 million euros in Germany.

See also

Web links

Wiktionary: Health insurance  - explanations of meanings, origins of words, synonyms, translations
Wikisource: Law on Registered Aid Funds. 7 April 1876. (Germany)  - Sources and full texts
Wikisource: Law relating to workers' health insurance. June 15, 1883. (Germany)  - Sources and full texts

Individual evidence

  1. ↑ One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries? In: ministerial-leadership.org
  2. ↑ Dominik Groß : Between aspiration and reality: The importance of dental treatment measures in the early days of statutory health insurance (1883-1919). In: Würzburger medical history reports 17, 1998, pp. 31–46; here: pp. 31–39.
  3. ↑ Germany: Development of the Health Care System. In: photius.com
  4. ^ Daniel Franke: The history of private health insurance. In: pkv-infos.net. Retrieved October 5, 2018 .
  5. ↑ Hartmut Milbrodt, Volker Röhrs: Financing separately, designing together: On the history of dual health insurance in Germany. University of Rostock, 2012
  6. ↑ Law to Strengthen Competition in Statutory Health Insurance (GKV Competition Strengthening Act - GKV-WSG) of March 26, 2007, Federal Law Gazette I, p. 387
  7. ^ Raimund Waltermann: Sozialrecht , Hüthig Jehle Rehm, 2009, p. 83
  8. ↑ 400,000 without insurance - a doctor's visit a luxury? In: n-tv.de, July 24, 2007.
  9. ↑ Fewer people without health insurance coverage. In: destatis.de.
  10. ↑ Ulrike Hummels: pain and no health insurance. In: dw.de, January 1, 2014.
  11. ^ Karl Lauterbach: The two-class state. How the privileged are ruining Germany. Rowohlt Verlag, Berlin 2007, ISBN 978-3-87134-579-1 , p. 221 .
  12. ↑ Study: With only one health insurance, premiums could drop noticeably. In: Handelsblatt. February 17, 2020, accessed February 20, 2020 .
  13. ^ Andrea Frühauf: Controversy over the abolition of private coffers flared up again . In: New Westphalian . Bielefelder Tageblatt. February 18, 2020, p. 1 .
  14. ↑ Cash registers are waiting for millions from abroad. In: orf.at , August 25, 2013