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Cui bono? - Die Bürgerversicherung und die Beihilfe


  • Christian Bührer


  • Steffen Fetzer
  • Christian Hagist


In der deutschen Gesundheitspolitik wird seit langem unter dem Stichwort Bürgerversicherung über die Einbeziehung aller Bürger in das System der Gesetzlichen Krankenversicherung diskutiert. Dabei wird meistens die Perspektive der GKV-Versicherten eingenommen, seltener diejenige der Versicherten der PKV. Es stellt sich jedoch insbesondere für die Gruppe der Beihilfeberechtigten die Frage, welche monetären Konsequenzen durch eine Bürgerversicherung für sie entstehen und in welcher Höhe daraus Kompensationszahlungen abgeleitet werden können. Unsere Ergebnisse zeigen: Selbst, wenn diese Kompensationen weniger als die Hälfte der Differenz der Versicherungsleistungen zwischen PKV/Beihilfe und einer Bürgerversicherung abdecken, hat der Business Case Bürgerversicherung für die Gebietskörperschaften zumindest kurzfristig negative fiskalischen Folgen. The health policy debate in Germany rotates around the question wheather Germany’s two pillar insurance system should be dissolved and replaced by universal coverage under the roof of the public system (so called „citizen insurance“/Bürgerversicherung). Most of the time, such a reform is argued from the perspective of the 90 percent of the German population which are already insured by a sickness funds. Rarely, the consequences of currently privately insurant are analysed. However, especially German civil servants are of great interest in this regard, as they are most times partly insured in the private scheme while the other part of their benefits are directly paid by the taxpayer. As the scheme for civil servants is more generous than the public scheme, the question of compensation arises when talking about the Bürgerversicherung reform. We show that if civil servants are only partly compensated by their employers (federal and state governments), the reform has a short-run negative fiscal impact.

Suggested Citation

  • Christian Bührer & Steffen Fetzer & Christian Hagist, 2017. "Cui bono? - Die Bürgerversicherung und die Beihilfe," WHU Working Paper Series - Economics Group 17-05, WHU - Otto Beisheim School of Management.
  • Handle: RePEc:whu:wpaper:17-05

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    References listed on IDEAS

    1. repec:zbw:rwimat:075 is not listed on IDEAS
    2. Martina Grunow & Robert Nuscheler, 2014. "Public And Private Health Insurance In Germany: The Ignored Risk Selection Problem," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 670-687, June.
    3. Augurzky, Boris & Felder, Stefan, 2013. "Volkswirtschaftliche Kosten und Nebenwirkungen einer Bürgerversicherung," RWI Materialien 75, RWI - Leibniz-Institut für Wirtschaftsforschung.
    4. Kathrin Roll & Tom Stargardt & Jonas Schreyögg, 2012. "Effect of Type of Insurance and Income on Waiting Time for Outpatient Care," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 37(4), pages 609-632, October.
    5. Friedrich Breyer & Normann Lorenz & Thomas Niebel, 2015. "Health care expenditures and longevity: is there a Eubie Blake effect?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 95-112, January.
    6. Christian Bührer & Steffen Fetzer & Christian Hagist, 2017. "Das Hamburger Beihilfemodell - Ein Vergleich der internen Renditen von GKV und PKV," WHU Working Paper Series - Economics Group 17-06, WHU - Otto Beisheim School of Management.
    7. Walendzik, Anke & Greß, Stefan & Manouguian, Maral & Wasem, Jürgen, 2008. "Vergütungsunterschiede im ärztlichen Bereich zwischen PKV und GKV auf Basis des standardisierten Leistungsniveaus der GKV und Modelle der Vergütungsangleichung," IBES Diskussionsbeiträge 165, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).
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    More about this item


    Health insurance; civil servants’ benefits; compensation;

    JEL classification:

    • H55 - Public Economics - - National Government Expenditures and Related Policies - - - Social Security and Public Pensions
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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