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Die Berücksichtigung von Zuzahlungsbefreiungen im RSA: Ausgestaltungsmöglichkeiten und Wirkungen einer erweiterten Berücksichtigung sozioökonomischer Faktoren

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  • Lux, Gerald
  • Schillo, Sonja
  • van der Linde, Kirsten
  • Walendzik, Anke
  • Wasem, Jürgen

Abstract

[Hintergrund und Ziele] Versicherte der GKV müssen bei der Inanspruchnahme zahlreicher Leistungen Zuzahlungen leisten, wodurch insoweit die Krankenkassen finanziell entlastet werden. Jedoch sehen die Vorschriften des SGB V sogenannte "Härtefall"-Regelungen für einkommensschwache Versicherte vor. Soweit Versicherte, nachdem die geleisteten Zuzahlungen 1% oder 2% des Einkommens erreicht haben, von den Zuzahlungen als "Härtefälle" nach § 62 SGB V befreit sind, oder beim Zahnersatz eine höhere Kassenleistung in Form eines doppelten Festzuschusses (§ 55 SGB V) erhalten, entstehen ihrer Krankenkasse Mehrkosten. Da die versichertenbezogenen Einkommen zwischen den Krankenkassen auch knapp 20 Jahre nach Einführung der Kassenwahlfreiheit immer noch sehr ungleich verteilt sind, besteht die Vermutung, dass sehr unterschiedliche Belastungen der Krankenkassen aus den "Härtefallregelungen" resultieren. Das Kriterium "Härtefall" ist im RSA nicht berücksichtigt, so dass hier eine potenzielle Quelle für Verzerrungen im Kassenwettbewerb liegt. Dieser Fragestellung und möglichen Lösungsansätzen geht die vorliegende Studie nach.

Suggested Citation

  • Lux, Gerald & Schillo, Sonja & van der Linde, Kirsten & Walendzik, Anke & Wasem, Jürgen, 2015. "Die Berücksichtigung von Zuzahlungsbefreiungen im RSA: Ausgestaltungsmöglichkeiten und Wirkungen einer erweiterten Berücksichtigung sozioökonomischer Faktoren," IBES Diskussionsbeiträge 207, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).
    • Handle: RePEc:zbw:udewwd:207
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    References listed on IDEAS

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