Pfeiffer regretted that the three parties could not agree, for example, to lower the VAT on pharmaceuticals to seven percent. This measure would have relieved the coffers by five to six billion euros.
“The fact that the traffic light wants to adjust the regular federal subsidy for non-insurance benefits of 14.5 billion euros to the increasing expenditure is an important signal,” said Pfeiffer. “But now it is important that the increase is determined in such a way that inflation and the increasing expenditure on benefits are mapped.” In addition, further questions remained unanswered in the coalition agreement.
You can read the entire interview here:
Ms. Pfeiffer, the coronavirus situation is getting worse. What does the healthcare sector have to prepare for in the coming months?
We see that the intensive care units in the east and south are full. At the same time, there are still free capacities in other federal states that are being used by relocations. But here, too, the health system could reach its limits in the foreseeable future. I really hope that more people will get vaccinated and be convinced that this will reduce the likelihood of a severe course.
Do you think a lockdown or a general vaccination is necessary?
This decision has to be made by politicians. I have at least one hope that people will be sensible and reduce their contacts. Personally, I can gain a lot from a general vaccination requirement. So far, not enough people have been convinced to get vaccinated. Vaccinated people must now also suffer from this, for example through threatened closings or restrictions.
Do you anticipate higher costs for statutory health insurance in the coming year due to the pandemic?
It’s hard to predict. On the one hand, policyholders go to the doctor less often and receive treatment less often, which in turn reduces expenses. At the same time, we have higher costs from treating Covid patients. At least for this year we don’t need any additional help.
In its coalition agreement, the traffic light promises a “departure into a modern, cross-sector health and care policy”. Can you see this departure?
The coalition agreement contains light and shadow. We welcome a whole range of points, such as faster digitization, the plan to structure the hospital landscape, or the plan to provide unnecessary inpatient treatment in clinics more on an outpatient basis. The question is, of course, how the measures will actually be implemented. To stick with the outpatient sector: The future traffic light coalition is planning so-called hybrid DRGs …
… in other words, remuneration for the outpatient area taken over from the hospital sector.
Exactly. And we see that with skepticism if the high hospital case lump sums apply, which include the cost of keeping large equipment, for example. This is an expensive measure, which is why we suggest using the outpatient remuneration as a benchmark instead. It is positive that the traffic light wants to address the financial position of the cash registers.
Here the coalition agreement promises “long-term stable financing”. Do you recognize them?
There are some measures that pay off. The fact that the traffic light wants to adjust the regular federal subsidy for non-insurance benefits of 14.5 billion euros to the increasing expenditure is an important signal. But now it is important that the growth is determined in such a way that inflation and increasing service expenditure are mapped. The financing of the health insurance contributions of unemployment benefit 2 recipients also relieves the health insurers considerably. But here, too, it depends on detailed questions – for example whether the entire costs are actually refinanced, which would be appropriate. These measures could then increase revenues by ten billion euros.
Are the measures sufficient? For the coming year alone, the federal government had to stabilize the coffers with a record grant of 28.5 billion euros.
That depends crucially on how the open questions are implemented. In general, statutory health insurance should not need federal funds in the long term to cover its deficits. Taxes should only come if the health insurances have to cope with tasks that affect society as a whole, such as financing the contributions of unemployed beneficiaries or civil protection in the pandemic. The traffic lights must carry out this regulatory separation cleanly. And she has to deal with other issues. The hospital sector is a crucial point here. During the pandemic in particular, it became clear that cases have to be treated in specialized hospitals and that it is not important to have a lot of hospitals everywhere.
Can the contributions of the insured remain stable in the coming years with these measures?
For 2022, the additional contribution has been stabilized by the supplementary federal grant. As far as the following years are concerned, the traffic lights will probably have to step up. In addition to the points mentioned, she should also have reduced the value-added tax on pharmaceuticals to seven percent. We regret that this did not happen. This measure would have brought five to six billion euros …
… which would have been missing elsewhere in the state budget.
Right. But the measures envisaged in the coalition agreement alone may not be enough to make up for the deficit. Therefore, at the present time, increasing contributions from 2023 cannot be seriously ruled out.
In care, insured persons can prepare for higher contributions, they should increase “moderately” according to the will of the traffic light. That would make the 40 percent target for social security contributions a thing of the past.
The goal is a promise made by the grand coalition, which will soon no longer be in office. To what extent the future traffic light coalition will feel bound by it, I cannot say. In general, we have to ask ourselves which contributions are reasonable. Apparently the traffic light wants to accept higher contributions in order to at least better finance long-term care insurance.
What level of social security contributions do you consider reasonable?
In the long run it makes no sense to draw in such borders. In the 1960s, health insurance premiums were less than half of what they are today. And at that time it was already said that the load capacity had been exceeded. This is a social decision that we have to make dependent on which services we want to finance – and which not. This balance cannot be permanently fixed with a number. After all, it is about the care of 73 million people with statutory health insurance.
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