Why is there private health care

Private health insurance: Unfair and risky


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You usually only notice how well a health system works when you really need it. In a representative survey by the management consultancy PWC, which was published at the beginning of the year, only 15 percent of those questioned were not satisfied with the services of their health insurance. You might think that everything is fine.

But there is unrest in political Berlin. The statutory health insurance companies warn of increasing contributions. They expect that the average additional contribution that each of the 72 million insured persons will have to pay alone will increase from the current 1.1 percent to 1.8 percent by 2019. For an employee with an income of 3,000 euros, this means: 252 euros more per year for health insurance. Health Minister Hermann Gröhe (CDU) was only able to prevent a price increase in the election year with an extra grant from the health fund.

The discussion arises again as to how good health care can remain affordable for the general public in the long term. German health care is unique in one respect: there are two fully-fledged systems that exist side by side and scramble for good customers - statutory and private health insurance. But the coexistence of two systems creates false incentives for policyholders and doctors.

Annika Krempel

Annika Krempel is editor of the non-profit consumer portal Finanztip.de and is part of the insurance and provision team.

With private health insurance (PKV), economically strong members of our society can avoid solidarity-based financing of health care. In contrast, the elderly, the sick or physically working people have hardly any access to private health insurance. Both the insurers, who are allowed to choose their customers, and the law, which currently stipulates a minimum income of 57,600 euros per year in order to be allowed to switch, prevent this. So while those who are susceptible to illness increasingly stay in the legal system, the healthy migrate.

Doctors attract private patients

For doctors, privately insured people are like the golden fleece. For the same treatment they get more money from private than from statutory health insurance. Every legally insured person who has tried to get an appointment with a specialist at short notice is familiar with a symptom of this unequal billing practice. Privately insured not only get an appointment faster, they also get it quicker. So that this is not so noticeable, they often sit in their own waiting room separately from the statutory health insurance patients. The coexistence of two systems leads to an unequal treatment of people who have the same needs.

The private providers like to argue that with their higher fees they help finance the health system and keep medical practices alive. But a 2013 study by the Bertelsmann Foundation shows that private health insurance in particular helps prevent needs-based care. Regions in which there are many privately insured people tend to be oversupplied with doctors. You can simply earn more there. In regions with few privately insured persons, however, there tends to be a lack of doctors.

Expensive private health insurance

But not all that glitters is gold for those with private insurance either. First of all, everything starts out very promisingly: Private health insurance companies lure young high-income earners with low-cost premiums, which are sure to be not only cheaper, but also automatically better insured. A mistake: Very few private insurances cover the basic services offered by the supposedly inferior statutory health insurances. Although there is usually a head physician treatment, other very important services often fall behind in the private sector: With some cheap offers with a small scope of services, areas such as psychotherapy, spa treatment or speech therapy are hardly insured. Anyone who needs the support of a psychotherapist after a burnout or learns to speak again with a speech therapist after a stroke, then has to pay for the long-term therapy themselves.

Such gaps are difficult to remedy afterwards: topping up benefits becomes more and more difficult with increasing age. Anyone who already has complaints must pay risk surcharges or exclude their illnesses from insurance cover.