News Fair money for all: funds want fairer financial compensation
Tuesday, 20.06.17 , written by Annabell Meyer The new federal government has not yet been elected, and the first demands are already coming. An alliance of replacement funds, company and guild health insurance funds calls for a quick reform of financial equalization. Because the previous regulation creates distortion of competition rather than equal opportunities in health care. That must change urgently. The money from the financial equalization is to be distributed more equitably
For years there is a dispute between the general local health insurance funds (AOKen) and many replacement health insurance as well as company and guild health insurance funds. The reason for this is the distribution of funds from the financial equalization. Because that would benefit only the AOKen , it is said by the critics. Recent figures of the Frankfurter Allgemeine seem to confirm the allegation.
According to the newspaper, the health insurances in the first quarter of 2017 apparently record surpluses amounting to 620 million euros . But while the AOKen were able to quintuple their reserves by a factor of five compared to the previous year, the substitute funds as well as the guild and company health insurance funds had to accept losses overall. They attribute this to the morbidity-oriented risk structure compensation, Morbi-RSA for short. This would favor the local health insurance and thus create an imbalance in the additional contributions. The new federal government must immediately end this distortion of competition, is the joint demand of the Alliance of 91 health insurance companies.
Suspected manipulation: funds use financial equalization
The financial equalization serves to compensate for risk differences between the health insurance funds. Some funds have many members who are older or suffer from chronic diseases. For these patients, the expenses of the health insurance are higher than for younger people, who only have to be treated occasionally because of a cold or flu. In order to reduce this imbalance, obtain health insurance with many patients at risk for financial compensation.
However, the principle has long been critical. Because some funds would make their members deliberately sicker to get as much money from the Morbi RSA. So there is a list of 80 selected diseases, the health insurance companies receive a grant of up to 1,000 euros in their diagnosis. A new study by Munich researchers now shows, on the one hand, that the number of these diagnoses has greatly increased since the introduction of risk structure compensation, and, on the other hand, that this is due to manipulative agreements between physicians and health insurers.
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More money for sick members: Prevention remains by the wayside
Critics see in the regulations of the financial equalization not only the danger to make the insured supposedly sicker. Rather, health insurances that campaign for effective prevention are subsequently punished for having less money. In the long term, this could lead to the funds lacking the drive to spend money on prevention measures.
This problem also names the Monopolies Commission in a special report on “Status and perspectives of competition in the German health insurance system”. As an independent body, it advises the Federal Government, inter alia, on competition law and competition policy. As the Handelsblatt reports, the Commission proposes to penalize health insurance funds when their sick leave rate increases significantly .
By contrast, the alliance of replacement funds as well as guild and health insurance funds is calling for a speedy reform of financial equalization. The corresponding statement states: “The Morbi-RSA must become tamper-resistant and fairer in the future.”
Compensation payments can influence cash contributions
The main criticism of the structural compensation for the alliance of health insurance funds is the uneven development of the contributions . For example, funds that receive a high level of support from the Morbi-RSA can keep their additional contribution permanently low. However, if a health insurance company receives only a few compensation payments, its overall expenditure will also be higher. To cover the costs, this could lead to premium increases. The victims are then the insured.
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- Annabell Meyer
- editorial staff
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