Jens Baas is the CEO of Techniker Krankenkasse.
(Photo: Imago, Techniker Krankenkasse)
Whether it’s a struggling maternity ward, rescue packages for caregivers or a lack of fever syrup: when a quick solution to an urgent problem is sought in the healthcare system, the “The health insurance companies will pay for it” approach is usually not long in coming.
Broad opposition to this political fire extinguishing “on cash” is mostly absent. The wording “that’s what the health insurers pay for” is misleading. Because we have no money of our own, we manage the money of the contributors. They, in turn, pay their contributions under the premise that they are used responsibly and for their actual purpose: to pay for care in the event of illness. Putting out political fires with them without eliminating their causes contradicts this premise.
It becomes even more problematic if contribution money is not only used for short-term deletion, but for permanent sprinkling. But that is exactly what we experience many times, also because politicians are increasingly dumping responsibility for society as a whole and for themselves on the shoulders of the contributors.
Contribution funds may only be used for social security purposes
There are numerous examples: For years, the federal states have only insufficiently fulfilled their obligation to finance the investment costs of the clinics. As a result, the insured have to cross-subsidize them through the treatment costs.
As before, the contributors bear the lion’s share of the health insurance of those who receive citizen benefit (formerly unemployment benefit II) – although that is actually the task of the state. That amounts to around ten billion euros per year – well over half of the most recent funding gap in statutory health insurance.
It’s not just about political legacy issues: the planned health kiosks – i.e. the advice centers in socially disadvantaged areas – are also to be financed primarily through contributions, although many offers are planned there that are not the responsibility of the health insurance companies. These offers are certainly helpful and necessary in many places – but these are tasks for society as a whole.
>>Read here: Why Germany has far too many clinics – and the emergency rooms are still overcrowded
Another example: the independent patient advice service is to be re-established as a foundation and, by statutory order, serve as an additional service for the population to provide advice on all health and health-related issues.
So that includes a wide range of topics that goes well beyond questions from the spectrum of health insurance.
The health insurance companies are supposed to take care of setting up the foundation, and the financing is provided by the contributors, although it is a task for society as a whole. In addition, there have long been numerous advisory services within the area of responsibility of the health insurance funds, for example for those affected by medical errors.
The administration costs of the cash registers account for only five percent of the service expenditure
Reflexively, in the public debate on spending, there is always a demand that health insurers should first save on themselves, i.e. reduce administrative costs and the number of health insurers. There is nothing wrong with lean structures, on the contrary.
However, this approach has natural limitations: administration costs only account for around five percent of the service expenditure of the cash registers, which roughly corresponds to the increase in service expenditure in one year.
Can the number of cash registers continue to decrease? Sure, but even that has its limits. Because without a certain variety, there would be no competition – and with it a strong incentive to stand out from the rest with service and innovations.
>>Read here: Ethics Council chief Buyx on ChatGPT in medicine: “I get very euphoric”
So what remains to be done? We have to move away from the principle of “The health insurers pay” or “The contributors step in”, which politicians use to buy peace at the expense of third parties. This may be politically convenient, but as a strategy it is neither fair nor sustainable.
It runs up against the wall at the latest when the money of the contributors is used up. This wall has long been in sight: the gaps in the billions are there, the reserves have been used up, and the contributions cannot continue to increase indefinitely.
So we need a health policy trend reversal towards a cause-related, sustainable reform policy. This includes hospital reform that distributes financial responsibility fairly, as well as fair prices for medicines.
Fair for the industry, which should get real innovations well paid, and fair for the community of solidarity, which cannot spend money on extremely expensive medicines without any real benefit, which above all drive up the share prices of the manufacturers.
The basis for this must be an understanding of politics that assumes responsibility in matters of social policy instead of delegating it to the contributors.
The author: Jens Baas is CEO of the Techniker Krankenkasse.
More: Nursing care reform Contribution shock in nursing care insurance threatens – Lindner lets Lauterbach accrue