Doctors can earn significantly more money treating people with private health insurance.
(Photo: Imago/Westend61)
Berlin A weakening or even an end of private health insurance (PKV) would possibly cost doctors and drug manufacturers dearly.
This emerges from the as yet unpublished study by the Scientific Institute of PKV on so-called additional sales, which is available to the Handelsblatt. It quantifies the additional revenue that private patients generate through higher doctor’s fees or the more extensive reimbursement of services and medicines.
In 2021, this totaled 11.68 billion euros – a slight increase of 1.3 percent compared to the previous year, when the additional turnover had fallen considerably. The authors attribute this to the pandemic.
The medical service providers would lose this amount of income per year if they had to settle accounts with privately insured persons according to the rules of statutory health insurance (GKV).
The additional turnover is also used as a counter-argument in the debate about citizen insurance. The SPD and the Greens have recently revived calls for a significantly higher contribution assessment ceiling in order to better finance the statutory health insurance system.
Economists spoke of a “citizen’s insurance through the back door” that would significantly weaken private health insurance because the change would only be possible for employees with a significantly higher income.
6.7 billion euros more for general practices through private health insurance
It is true that the statutory health insurance companies bear the vast majority of the costs in the health care system. In 2021, they spent almost 224 billion euros on services, while private health insurance only spent 40 billion. According to the study, however, the additional sales make up a considerable part of sales in the healthcare system.
This has a particularly strong effect in the outpatient area. According to the 2021 study, the additional turnover for resident doctors was on average 58,000 euros per practice and a total of 6.74 billion euros. According to this, the private health insurance accounts for around 10.5 percent of the insured, but contributes a little more than 20 percent of the income of the resident doctors.
For dentists, the average additional turnover was even more than 61,650 euros and a total of 2.88 billion euros. In hospitals, on the other hand, the additional turnover was negative at 300 million euros. Hospitals would have been in a slightly better position without private insurance. Uniform fees are charged there.
The numbers also play a role in the negotiations on a new fee schedule for doctors (GOÄ). This regulates the billing of medical and dental services outside of statutory health insurance and is considered outdated in its current version. So far, however, the German Medical Association and the PKV Association have not been able to agree on the prices of services.
>> Read more: PKV vs. GKV – What are the differences and how to find the best offer
From the point of view of private health insurance, the additional sales study shows that, despite complaints from some medical officials, there is still a reasonable increase in income in the practices. However, private health insurance is pushing for an amendment, just like the President of the German Medical Association, Klaus Reinhardt.
“An agreement is still pending,” Reinhardt told the Handelsblatt. However, it is the task of Health Minister Karl Lauterbach to get an appropriate fee schedule in place. The fact that the latter has so far ignored the implementation is a “scandal and difficult to bear”.
President of the German Medical Association: Private health insurance contributes to good care
The current schedule of fees is no longer transparent for insured persons and doctors because they do not reflect many modern medical services. “Doctors’ practices and hospitals are forced to bill them using auxiliary constructions, so-called analogue numbers,” said Reinhardt. “This leads to more bureaucracy and legal disputes that could be avoided with a new fee structure.”
The President of the German Medical Association is pushing for a revision of the fee schedule.
(Photo: dpa)
Reinhardt also warned against a significant increase in the contribution assessment ceiling, as demanded by the SPD and the Greens. “The private health insurance brings a higher contribution margin per insured person for practices than the statutory health insurance and thus contributes to good care, from which the statutory insured also benefit,” he said.
A weakening would affect this effect and the structures created by it. “In the countryside, practices could be much more difficult to exist,” he said. This would massively weaken the supply. “The additional turnover stabilizes the rural medical practices.”
More: Greens and SPD are targeting private health insurance companies