Health Insurance System Reform: Is Single Statutory Insurance on the Cards?

The German healthcare insurance system has faced criticism for years. There is a need to reform both the statutory and the private insurance system. Is a single statutory insurance market the solution? Peter Oberender and Jürgen Zerth, University of Bayreuth, do not see the introduction of citizens’ insurance as an appropriate instrument for addressing the respective weaknesses of the statutory and private health systems. In the opinion of Stefan Felder, University of Basel and CINCH Essen, the three-way split of the German health insurance system is historically obsolete, inefficient and questionable in terms of earnings policy. It is also a growing burden on the German economy. In his view, a private citizens’ insurance scheme with transferable individual pension provisions, supplemented by state transfers for low-paid workers, would be an alternative. He sees a unified system, designed along the lines of the statutory health insurance system on the basis of flat-rate health premiums specific to individual health plans that are linked to risk structure compensation and enjoy individual premium reductions, as a second reform option. Martin Nell, University of Hamburg, argues in favour of a reform of the dual system, which would create the conditions for fair competition under which both statutory and private health insurance funds must stand their own. In his opinion, the introduction of citizens’ insurance would mean the phasing-out of the dual system in favour of a state-imposed, single insurance market without any significant product diversity and at grave legal risk. Bernd Raffelhüschen and Christian Hagist, University of Freiburg, present an alternative to the single statutory insurance system: namely a “new duality” in health insurance, whereby doctors and hospitals would turn into companies that wish to, and should, earn money by providing healthcare services. Patients would be their customers and would receive a bill for their services, which they would pay and carefully check themselves, since they would only be reimbursed a certain percentage of it.