Buergerversicherung vs. Gesundheitspraemie – Vergleich der Reformoptionen zur Finanzierung der Gesetzlichen Krankenversicherung

The wage-dependence of the Public Health Insurance (PHI) as well as the somewhat inconsistent parallel coverage via PHI and private health insurance constitute drawbacks of the present health care revenue system, leading to undesirable distributional and allocative patterns and disadvantages in the course of demographic and economic change. Two conflicting approaches, the “Buergerversicherung” (“Citizens’ Health Insurance”) and the “Gesundheitsprämie” (“Flat Rate Health Insurance”) try to remedy these by way of different methods – the former with a statutory health insurance for all and a comprehensive income basis for proportionate health insurance contributions, the latter with a flat rate contribution for the present PHI including a massive tax subsidy for the contributions for low-income groups and children. The paper presents simulations of the distributional effects. Differing effects become evident. Moreover these patterns also reflect different “philosophies” of social welfare and public revenue regimes. The “Bürgerversicherung” reduces payments by wage and wage-replacement earners and generally by low income groups, the “Gesundheitspraemie” favors higher-income individuals and particularly two-earner married couples.