Statutory health insurance: billions that put Lauterbach under pressure

The financing of the statutory health insurance companies must be reorganized because billions are missing. On the course: Minister of Health Lauterbach. The suggested solutions could lead to further arguments at traffic lights.

Many projects have accumulated on the desk of the Federal Minister of Health. The healthcare system is to be digitized, the legalization of cannabis is proving to be more difficult than expected and the hospital reform is also calling for the minister.

But while Karl Lauterbach is struggling with the federal states to put the hospital landscape in Germany on a new footing, new adversity threatens. Health insurance companies fear that several billion euros will be missing again in 2024.

A debate has long been going on as to how the finances of the health insurance companies could be permanently stabilized. There are really only three options: earn more money, spend less money, or distribute the money differently.

Pay for the dentist visit yourself?

The head of the statutory health insurance company IKK-Innovationskasse wants to spend less money. Specifically, Ralf Hermes proposes cuts in three areas: dental treatments, dentures and homeopathy. “It would be appropriate for the situation to remove all dental care from the catalog of services.” That would mean that the insured would have to pay for their root canal treatment, dental fillings and any dentures themselves. Hermes wants to rely on private supplementary insurance and pensions. “Anyone who brushes their teeth properly essentially twice a day will have almost no problems.”

Statutory health insurance could save a lot of money as a result. According to the Association of Substitute Health Insurance Funds, around 16 billion euros are spent on dental care and dentures every year. Pay for the dentist visit yourself? The Federal Minister of Health rejected this proposal directly. “We can save money if we avoid superfluous operations or carry out more necessary interventions on an outpatient basis,” says Lauterbach, clearly speaking out against cuts in benefits.

Up to seven billion are missing

But the money has to come from somewhere. The GKV assumes a gap of up to seven billion euros. Without further measures, the insured would have to pay for it.

Doris Pfeiffer, Chairwoman of the Board of Directors of the National Association of Statutory Health Insurance Funds, assumes that the additional contributions would then have to increase by up to 0.4 percentage points. She is concerned about the financial situation, also because the population is getting older and more people will need medical care in the future. She calls for a long-term solution so that the financial gaps do not have to be filled with increases in contributions and tax subsidies every year.

Lauterbach refers to Lindner

The Federal Minister of Health is obliged to submit recommendations for stable financing of statutory health insurance. This is laid down in the so-called GKV Financial Stabilization Act, which was passed by the Bundestag and Bundesrat last October. In particular, the “expenditure side of the GKV” should also be considered, according to the law. A tricky formulation, because it could point to exactly what Lauterbach wants to avoid: that fewer services are paid for by health insurance companies.

The law stipulates that recommendations must be available by the end of May on how stable financing for health insurance companies should look in the future. This date was also agreed with a view to the budget planning of the funds for the year 2024.

The Federal Ministry of Health is covered in relation to the recommendations. Lauterbach justifies the delay and refers to the Federal Minister of Finance. Because the federal government is still struggling over the budget for the coming year. The internal government consultations are ongoing, says Lauterbach. After all, an “early check” of his proposals is underway.

opposition to reform plans

“I don’t know of any recommendation yet,” says Pfeiffer from the National Association of Statutory Health Insurance Funds. A certain unrest can therefore be felt among the health insurance companies. This is also due to the state of the traffic light government. You can see at various points how tedious it is to get laws on the way. She hopes that there will soon be clarity so that the health insurance companies can start their budget planning.

The current law only secures the finances of the health insurance companies for this year. In order to save money, Lauterbach had alienated important players in the healthcare system last year: the medical profession resisted the abolition of the new patient regulation, which provided for better remuneration for new patients, the pharmacists against increasing the pharmacy discount they had to pay the health insurance companies for every pack of medicines and the pharmaceutical industry protested against an increased manufacturer discount, especially for patent-protected medicines. A pharmaceutical company has since sued.

The health insurance companies have been demanding structural and permanent changes for a long time, for example that the federal government should take over the contributions of people receiving citizen benefits. According to calculations by the cash registers, around ten billion euros in contributions could be saved each year. The money would then have to come from the federal budget.

The FDP relies on savings

In the coalition agreement, the traffic light parties had actually agreed on this measure. However, the FDP does not see an income problem, but an expenditure problem. In other words, from the point of view of the liberals, savings must be made. Paula Piechotta from the Greens points out that the German healthcare system is one of the most expensive in an international comparison. She is concerned with using the money more effectively so that patients receive better care.

It is already clear: In view of the tight budget situation, Finance Minister Lindner has less to distribute. Many legislative projects, including those from the Federal Ministry of Health, are therefore on hold. Negotiations on a permanent stabilization of the health insurance companies are likely to be difficult.