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Das Hamburger Beihilfemodell - Ein Vergleich der internen Renditen von GKV und PKV


  • Christian Bührer


  • Steffen Fetzer
  • Christian Hagist


Zu Beginn ihrer Karriere verfügen Beamte über das Privileg zwischen einer Absicherung im System der gesetzlichen Krankenversicherungen (GKV) und den privaten Krankenversicherungen (PKV) wählen zu dürfen. Bislang entscheiden sich die meisten Beamten für letztere, auch weil sie in der GKV sowohl Arbeitnehmer- als auch Arbeitgeberbeitrag zahlen müssten, in der PKV dagegen eine Kostenbeteiligung im Rahmen der Beihilfe vorgesehen ist. Die Stadt Hamburg hat nun jedoch beschlossen, zukünftig Arbeitgeberzuschüsse zur GKV zu leisten, um damit eine „echte Wahlfreiheit“ herzustellen. Wir zeigen anhand eines Vergleichs der internen Renditen in beiden Systemen, dass sich das Kalkül für den Durchschnittsbeamten trotz dieser gefeierten Reform kaum verändern wird. Vielmehr wird es wahrscheinlich zu einer verstärkten adversen Selektion von hohen Gesundheitsrisiken zu Lasten der GKV kommen. At the beginning of their career civil servants in Germany can choose between the social health insurance system and a private plan combined with a direct reimbursement of the government up to 80 percent. Most civil servants chose the latter, also because they have to cover all contribution payments to the social system themselves, while normal employees get nearly 50 percent from their employers. The state of Hamburg decided to change the system by paying a share of the contributions if civil servants choose the social plan. Using a comparison of internal rates of return in both schemes, we show that this celebrated reform will not change the decision calculus for the average civil servant household and will probably thereby increase the adverse selection of high risk cases towards the social health insurance.

Suggested Citation

  • 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.
  • Handle: RePEc:whu:wpaper:17-06

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    References listed on IDEAS

    1. 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.
    2. 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.
    3. Kifmann, Mathias & Nell, Martin, 2013. "Fairer Systemwettbewerb zwischen gesetzlicher und privater Krankenversicherung," hche Research Papers 2013/06, University of Hamburg, Hamburg Center for Health Economics (hche).
    4. 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), pages 95-112.
    5. Metzger, Christoph, 2016. "Intra-household allocation of non-mandatory retirement savings," FZG Discussion Papers 60, University of Freiburg, Research Center for Generational Contracts (FZG).
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    Cited by:

    1. 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.

    More about this item


    Health insurance; internal rate of return; adverse selection; civil servants’ benefits;

    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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