The good news first of all: Despite the lack of billions, there should not be any reductions in benefits in the statutory health insurance system in the coming year for the more than 73 million people with statutory health insurance in Germany. That’s what Federal Minister of Health Karl Lauterbach (SPD) said yesterday when presenting the key points of the comprehensive GKV financial reform.
Lauterbach spoke of a “good compromise that avoids cuts in benefits and does not overwhelm the federal government in terms of tax financing”. The draft, which was agreed after “very intensive negotiations” and “good cooperation” with Federal Finance Minister Christian Lindner (FDP), was voted on by the departments yesterday. The Minister of Health expects the Bundestag to deal with the matter quickly.
The bad news: Because the health fund will lack at least 17 billion euros in the coming year, the additional GKV contributions will have to increase by 0.3 contribution rate points. This year, a corresponding underfunding was avoided by an additional federal subsidy of 14 billion euros. This special subsidy is not planned for the coming year. “I don’t think it’s wrong if we increase the contribution rates if we enable our health system to continue to provide high-quality, quality care for everyone,” Lauterbach said.
billion from other sources
The increase in additional contributions should bring in 4.8 to 5 billion euros. Further funds are said to come from an increased tax subsidy of two billion euros and a federal loan to the health fund of one billion euros. Finance Minister Lindner, Lauterbach reported from the negotiations, was very careful “that we do not come to proposals that endanger the debt brake, tax increases or make a supplementary budget necessary”. He himself was primarily concerned with avoiding cuts in benefits.
For this it is necessary to “use further reserves that are located at the individual cash registers”, Lauterbach continues. According to the minister, the cash reserves are to be reduced by a total of four billion euros. Another 2.4 billion euros are to be withdrawn from the health fund. These measures should cover a little more than 14 of the missing 17 billion euros.
Criticism comes from the health insurance companies
Criticism from the cash register was not long in coming: “From today’s perspective, it is still unclear whether the increase in the additional contribution rates planned by politicians by 0.3 percentage points will actually be sufficient. However, it is already certain that politicians will now use up the last reserves of the health insurance funds for short-term effects. We sharply criticize the encroachment on the financial sovereignty of the individual health insurance companies,” said Doris Pfeiffer, Chairwoman of the Board of Directors of the National Association of Statutory Health Insurance Funds. The key points presented would “at best give the GKV a financial respite”.
Jens Baas, the head of the largest German health insurance company, Techniker Krankenkasse, spoke, like many of his colleagues, of “short-term measures” that would not replace “sensible and sustainable structural reforms”. The only thing that is permanent and sustainable about Lauterbach’s concept is the increase in contributions for the insured, Andreas Storm told the Tagesspiegel. “In the future, you will have to pay even more for a promise of performance that has become more uncertain,” said the head of DAK-Gesundheit.
Another three billion euros are to be raised through efficiency improvements. The Minister of Health pointed out that the research-based manufacturers in the pharmaceutical industry had consistently achieved “considerable sales growth” over the past four years. Therefore, the pharmaceutical industry should be given a “one-off, sales-related solidarity levy of one billion euros”. Sales of corona vaccines and corona therapeutics are not taken into account.
The goal is to cover the cost of care
In addition, double payments made for care services by the GKV are to be corrected. A change in the law in the last legislature stipulated that the clinics would be paid the expenses for nursing staff outside of the case flat rates by the health insurance companies. Covering the cost of care was intended to break a vicious circle that arose from the fact that the clinics were trying to increase their revenues through savings in care – among other things to finance investments for which the federal states are actually responsible.
According to Lauterbach, clinics should then have booked services as care that was not close to the bed. The adjustments are still pending, but are necessary in order to avoid double payment for care by the GKV.
In addition, the new patient regulation introduced under Health Minister Jens Spahn (CDU) in the Appointment Service and Supply Act is to be deleted. It provides for services for new patients in the practice to be remunerated extrabudgetarily and should provide an incentive for doctors to treat additional patients in the quarter.
No talk of a VAT reduction
Additional reforms in the area of drug pricing would still be discussed with the Federal Ministry of Economics. Lauterbach spoke of a “spending-restricting reform of the Drug Market Reorganization Act” that will be implemented in the GKV Finance Act. However, Lauterbach did not mention a reduction in value added tax for pharmaceuticals from 19 to 7 percent, which the health insurance companies have repeatedly demanded. According to the Central Association of Statutory Health Insurance, it would have meant that the Federal Minister of Finance would be short of six billion euros.
A solution to the current underfunding of health insurance coverage for the long-term unemployed is also to be worked on with the Federal Ministry of Labor. “The problem has yet to be solved,” said Lauterbach. According to the GKV, the actual costs are currently more than 2.5 times the monthly flat rate that the health insurance companies receive for each ALG II recipient. A corresponding reform was already announced in the coalition agreement