Statutory health insurance: economics makes clear demands

Economics suggest

GKV: Additional payments could be omitted for this group

Additional payments in the statutory health insurance are increasing, and the burden is growing, especially for people with low incomes. Economists are pushing for reform.

Statutory health insurance has a spending problem. In recent years, expenses have risen significantly faster than income. This is unlikely to change in the coming years due to changing demographics, unhealthy lifestyles, but also medical and technical progress – the health system will continue to need more money in the future.

The increased expenses must primarily be paid by the insured. In its annual report presented on Wednesday, the Economic Advisory Council – the so-called economic experts – assumes that the contribution rate will increase significantly in the coming years. While this is currently an average of 17.5 percent of gross income, it is expected to rise to an average of 17.7 percent next year and to 18.2 percent by 2030. Economists believe an increase to 19.8 percent is conceivable by 2040, and by 2080 the health insurance contribution could then rise to 22.5 percent of gross income. In an extreme scenario, economists believe a contribution rate of 28.8 percent is possible by 2080. As a result, employees would have to pay an ever higher proportion of their income to statutory health insurance.

Reforms are therefore also off the table the recently passed Statutory Health Insurance Contribution Rate Stabilization Act urgently necessary. Economists look primarily at the expenses of statutory health insurance. In addition to reducing the costs of hospital treatment and medication, the focus is particularly on strengthening prevention and the targeted use of cost sharing.

Little exercise, poor nutrition, lots of alcohol and cigarettes: lifestyles that are harmful to health cost the healthcare system billions of euros. Estimates suggest that obesity alone puts an annual burden of 28 billion euros on the health system. When it comes to prevention, Germany performs poorly in an international comparison according to the Public Health Index of the AOK Federal Association and the German Cancer Research Center: tobacco and alcohol are always available, products containing sugar and fat are not taxed separately.

Although it has Federal Government lastly, taxes on alcohol and tobacco increased and an additional tax on sugary drinks is also planned. Nevertheless, economists see a need for further action here. Taxes on foods that are particularly high in fat and sugar would also be conceivable. These should be designed as incentive taxes and based on the respective ingredient content. This would not only encourage consumers to change their behavior, but also manufacturers to reduce the amount of taxed ingredients.

In the short term, this would place a greater burden on poorer households in particular. In the long term, however, this group would benefit from the new taxes, as their steering effect means that people with lower incomes in particular will adjust their consumption behavior. Economists argue that they would benefit the most over their entire lives.

Because of the changed consumer behavior, the risk of chronic diseases such as diabetes, cardiovascular diseases or cancer decreases disproportionately. Those who stay healthy longer are less likely to be chronically ill or unable to work. As a result, these people in particular would have lower healthcare costs and earn more money over their lifetime.

According to economists, the health insurance companies’ bonus programs only have a small influence on preventive behavior. What is often rewarded here is not behavioral changes, but rather existing behavior. In order to actually persuade those insured to change their behavior, health insurance companies should only use their bonus programs to promote services that have proven additional health benefits.