Discussion on Health Insurance: An Efficient Health Care System Based on Solidarity – How Could it Function?

The exploratory talks between the Union (CDU/CSU) and the SPD have returned the debate on health insurance reform to the political agenda. There will be no "civic insurance scheme" that would abolish the separation of private and statutory health insurance. But a reform of the health insurance system in Germany is needed to ensure efficient and solidarity-based healthcare. Thomas Drabinski, Institute for Microdata Analysis, Kiel, assesses the starting point for reforms in the German healthcare system as difficult on the whole. In the area of statutory health insurance, legislators would have to clearly retreat from a policy favouring a single insurance fund and towards a governmental medical system, and in the area of private health insurance they would first have to consider reforms that are in accord with the social market economy. Because of demographic change, it is not be possible to continue at the current level of financing and care in the dual system of statutory health insurance and private health insurance. Doris Pfeiffer, National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), points out that with statutory health insurance for 90 percent of the population, Germany has not only a stable, functioning and highly accepted health care system, but also one that is based on solidarity and is highly committed to economic efficiency. At the same time, there is a considerable need for reform: with regard to a solidarity-based structuring for the self-employed and recipients of unemployment benefits, with regard to the efficiency of in-patient care, emergency care and the provision of medicines. Stefan Gress, Fulda University of Applied Sciences, argues that in the long term there is no alternative to a civic insurance scheme, whose core element is the integration of statutory and private health insurance. In addition, insurance contributions for other types of income is urgently needed. For Mathias Kifmann, University of Hamburg, the coexistence of statutory and private health insurance has not led to meaningful systems competition but instead results in a selection competition. An alternative concept of "fair systems competition" would assure that every citizen can choose between statutory health insurance and private health insurance within the framework of a reorganised systems competition. In opting for a system, the solidarity premium that citizens contribute and receive would no longer be influenced because they would make an income-related contribution to a health fund. Thus, the new system would not only ensure a redistribution between high and low incomes but would also achieve solidarity between good and poor health risks.