What is secondary health insurance

Health services

The clarification of the term depends on the delimitation of the health sector. In the health expenditure statistics of the Federal Statistical Office, health services i. e. S. essentially preventive and supervisory measures, treatment, post-illness benefits as well as training and research, to the services i. w.S. in addition z. B. early pensions to surviving dependents or occupational health and safety measures (health expenditure). When it comes to the financing of health care services, a distinction can be made between two levels of financing. At the primary level, funding comes from public budgets, employers and private households. The secondary financing level includes the statutory health insurance and accident insurance providers, pension insurance and private health insurance. In addition to the financial requirements (e.g. continued payment of wages by employers), the social security contributions for statutory health insurance, which are levied in the context of compulsory insurance according to the principle of solidarity, are a main source of financing for health services. Private health insurance is financed according to the principle of equivalence. Reform considerations that see a reason for the misallocation of health services in the current form of financing the statutory health insurance are aimed at a dual system of health insurance with dynamic basic care and individual supplementary insurance. In such a system this could e.g. Z. the prevailing benefit-in-kind principle will be replaced by the cost reimbursement principle; Risk surcharges, optional tariffs and deductibles would apply. When it comes to health services, a distinction is made between outpatient and inpatient services. The providers in the outpatient sector include, in particular, resident doctors and dentists, as well as pharmacies and providers of remedies and aids. In the past, freedom of establishment was of decisive importance for the provision of doctors; In view of the "medical glut" to be expected, the requirement planning by statutory health insurance providers and the admission to medical studies come to the fore. The inpatient area includes acute and special hospitals. The number of funded planned beds in hospitals is largely determined by hospital requirements planning. The supply of health services and its structure are decisively influenced by the form of financing of the health care providers. The remuneration system of individual service remuneration in outpatient medical care creates incentives for polypragmasy, while the structure of the fee schedule in the past brought about a strong expansion of medical-technical services at the expense of the so-called actual medical services. The dual system of hospital financing anchored in the Hospital Financing Act (KHG) in 1972, which provides for separate financing of investment costs by the federal and state governments on the one hand and the operating costs by the care rates on the other, was used for the so-called "Bettenberg" and the excessive increase in Expenses for inpatient services held responsible. Reform approaches for a demand-oriented control of the supply of health services indicate, among other things. on a replacement of the quota control pursued with the concerted action in the health care system in favor of a health care system that is more organized on the market economy. The demand for health services is influenced not only by morbidity factors (such as age and gender) but also by aspects of the prevailing health system. A financing illusion of the citizens based on a high proportion of tax and social security contributions financing of health services and a usage incentive associated with comprehensive health insurance cover and a broad interpretation of the concept of illness lead to an expansion of demand as well as supply-side influences, such as supply-induced demand. In addition, due to the demographic development in the Federal Republic of Germany, an increase in the care risk for old people and a correspondingly increased demand for care services can be expected. A reform of the financing of the health system is expected to strengthen the autonomy of demand and to increase the needs-based justice of health services. Measuring the efficiency of health services poses significant problems, which are documented in the multitude of health indicators. Literature: Henke, K.-D., Health expenditure and distribution, Part A, Göttingen 1977.

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