Citizen Insurance

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In Germany, the term citizen insurance refers to various concepts of a social security system based on solidarity with the characteristic that without exception all citizens and including all types of income make contributions to the statutory health insurance and all citizens can claim the same benefits in the event of an insured event. Citizen insurance means the abolition of the dual system between statutory and private health insurance in the area of basic care . In most concepts, special medical benefits over and above basic care should continue to be possible through private supplementary insurance.

basis

Fundamental goals of the advocates of public health insurance are to reduce health care expenditure, to abolish one of the two-tier medicines that they criticize , in which insured persons with statutory and private health insurance are treated differently, and to achieve more social justice. They promise higher income for statutory health insurance as well as greater efficiency and thus cost savings in order to enable a higher level of basic care. Furthermore, more social justice should arise both in the solidarity-based contribution financing, which would result in a stabilization or even a reduction in health insurance contributions, and in the quality and use of insurance benefits. In addition, distortions in the competition between statutory health insurance doctors and private health insurance doctors are to be reduced.

The SPD , Bündnis 90 / Die Grünen and Die Linke favor the transformation of the existing health insurance into a citizens' insurance , while the CDU and FDP reject this. The health department of the ver.di union and the Association of Democratic Doctors are also in favor of citizens' insurance. The NAV-Virchow-Bund and the Marburger Bund speak out against it.

According to a survey commissioned by IG Metall in 2016, two-thirds of Germans support citizens' insurance.

Some models of citizen insurance also want to apply the principle to statutory pension insurance . In addition, the professional pension schemes are to be abolished.

Citizen insurance concepts

There are roughly two different concepts for citizens' insurance:

Citizen Insurance

All citizens pay a certain percentage of the sum of all their own income (wage labor, investment income, rental income, grants and other income) into the citizens' insurance, if necessary up to the assessment ceiling . In the sense of equal contributions, half of the amount is paid by the respective employer for dependent employees.

It is controversial whether the cap on contributions for particularly high earners (contribution assessment limit) is constitutional and therefore mandatory, since with compulsory insurance, the contribution must always be in a reasonably compatible relationship to the performance. The concept is intended to improve the income situation of the statutory health insurance companies to such an extent that reductions in benefits can be avoided. When the term citizen insurance is used in media coverage or in political discourse, this is almost always meant.

Health premium, flat rate per capita

The term citizen insurance was extended to the concept of the “ health premium ”. All citizens pay the same amount (head premium, citizen premium) into the insurance. In the case of low wage earners, this would be subsidized from tax revenues. The contributions for children are also to be raised from tax revenues. The concept of the Union provides that only those currently legally insured are included. The self-employed , civil servants and higher earners should not be directly affected by this and help finance the solidarity compensation (free co-insurance for children, support for low-income people) through income tax (which has no income threshold). The German Trade Union Confederation (DGB) sees the proposal of the health premium as “no solution”.

comparison

Citizens' insurance (with an assessment ceiling ) and health premiums are not absolute opposites. A hybrid form is also discussed in the political debate.

International

A study by the Scientific Institute of Private Health Insurance (WIP) came to the conclusion, as part of an international comparison of uniformly organized health systems, that rationing is carried out in all systems: while tax-financed health services restrict their services primarily through waiting times and limiting the patient's freedom of choice, contribution-financed health services would be limited Health insurance systems require co-payments more often. In recent years, however, this system has developed into an oligopoly and in some cases shows significant increases in contributions. Investments fell, wages of health workers were cut or frozen, co-payments increased and waiting times increased further. Exclusions from benefits would occur in all systems that would lead to alternative actions on the part of the insured person to obtain the benefit privately. The dual system in Germany would lead to fewer differences in care and would have done well.

In the Dutch model of citizen insurance, all citizens have been privately insured since 2006. The private insurance companies are, however, subject to extensive state framework regulation.

criticism

On the 116th German Medical Conference on May 28, 2013, the President of the designated German Medical Association , Frank Ulrich Montgomery , the national insurance policy for a "sham" and a "turbocharger for two-tier health care" because who could afford to insure themselves additionally privately would.

The Association of Private Health Insurance opposed the introduction of citizens' insurance . The experience in the Netherlands or Great Britain shows that “in such standardized systems” only people “who can afford it” have access to “top-quality medicine”. The association sees a "threatened reduction in health services" and a disadvantage for the middle class. "The efficiency of the German health system" is based on the "two-pillar model of private and statutory health insurance".

In a working paper from the union -affiliated Hans Böckler Foundation from June 2013, the author Robert Paquet does not agree with the formulations of the private health insurance, but is skeptical. The BV concepts of the SPD , the Greens and the Left have not dealt with the problems of structural change in medical offers, but also in private supplementary insurance, as well as with possible containment strategies for such developments . In addition, up to 100,000 jobs would be lost in private health insurances, some of which would be created in statutory health insurances.

According to the prognosis of the Association of Private Medical Clearing Offices (PVS) from May 2013, every resident doctor would have to expect an average annual loss of around 43,000 euros in sales.

The Association of Bavarian Economy wants to prove with its own citizens 'insurance calculator that citizens' insurance would also put a considerable burden on employers due to the associated increase in the contribution assessment ceiling . In 2013, only 13 percent of those with private health insurance would earn more than the income threshold as employees.

A report by the Arbeiterwohlfahrt (AWO) claims that the citizens 'insurance is in accordance with the Basic Law : The authors of the study Greß and Bieback reject the criticism that the citizens' insurance cannot ensure a fair distribution of the burdens . The financing problem of the cash registers could also be solved sustainably.

See also

literature

Web links

Individual evidence

  1. ↑ Heinz Rothgang, Dominik Domhoff, University of Bremen: Contribution rate effects and distribution effects of the introduction of a "solidarity health and long-term care insurance", expert opinion on behalf of the parliamentary group DIE LINKE and the Rosa-Luxemburg-Stiftung. (PDF) 2017, accessed on January 13, 2018 .
  2. ↑ What the parties are planning in the health system. In: tagesschau.de. September 13, 2017. Retrieved November 29, 2017 .
  3. ↑ Citizens' insurance for everyone. In: verdi.de. ver.di Department of Health, January 1, 2011, accessed on January 13, 2018 .
  4. ^ Association of Democratic Doctors (ed.): Programmatic foundations of the vdää . Maintal November 25, 2012, p. 53-60 .
  5. ↑ Citizens' insurance: no, thanks! NAV-Virchow-Bund, archived from the original on January 14, 2018 ; accessed on January 13, 2018 .
  6. ↑ Marburger Bund considers citizens' insurance to be anti-social. December 4, 2017, accessed January 13, 2018 .
  7. ^ IG Metall survey: Two thirds for citizens' insurance. In: Doctors newspaper. Retrieved June 22, 2017 .
  8. ^ Election program of the DIE LINKE party for the 2017 federal election. (PDF) June 11, 2017, accessed on January 13, 2018 .
  9. ↑ Government program 2017-2021. (PDF) SPD, accessed on January 13, 2018 .
  10. ↑ Citizens' insurance instead of a flat rate per capita . (PDF) Reform Commission “For a future health system based on solidarity” of the DGB Federal Executive, Social Policy Department, December 2010; Retrieved November 29, 2017
  11. ↑ wip-pkv.de
  12. ↑ The example of the Netherlands shows: Citizens' insurance could be expensive for taxpayers. In: www.focus.de. December 21, 2017. Retrieved July 29, 2019 .
  13. ^ 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 29, 2019 . Pp. 369-375.
  14. ↑ Medical president accuses health insurance companies of defamation. In: Süddeutsche Zeitung, May 28, 2013. Accessed August 17, 2016.
  15. ↑ Beware of citizens' insurance! In: PKV Association of Private Health Insurance. Retrieved August 17, 2016.
  16. ↑ Robert Paquet: Effects of citizens' insurance on employment in statutory and private health insurance. Working paper 284, order no. 11284, published by Hans-Böckler-Stiftung , Düsseldorf, 2013. Retrieved on August 17, 2016.
  17. ↑ Forecast of the PVS Association ( Memento from October 12, 2013 in the Internet Archive )
  18. ^ Citizens' insurance calculator , the Association of Bavarian Business
  19. ↑ On the feasibility of citizens' insurance in the event of illness and need for care. (PDF) accessed on September 6, 2013.