MEDICA.de talked to professor Günter Neubauer, director of the Institute for Health Economics in Munich about nationalising the German health care system, about those being on the losing side and why doctors and insurances now will start to compete for patients.
MEDICA.de: Mr. Neubauer, how does the fund improve the German health care system?
Günter Neubauer: The fund does not improve the system, it will change the system in another way: It will be nationalised because the government decides on a uniform fee for all insured people. Due to the collapsing economy it will not be possible to fill up the fund with the needed 166.8 billion Euros. Then the state will have to grant a bridge loan which means that more debts will result from this.
MEDICA.de: Are there going to be people that will lose because of the fund?
Neubauer: Yes, many people will be losing. The young and health-conscious people for example that used less services were insured with lower fee so far. Even though these insurances would have raised their fees anyway since doctors and hospitals get more money from 1 January. However, not as much as with the fund now. Also employees are going to be on the losing side since they have to pay any additional fees themselves without a contribution made by the employer. And last but not least, small insurances are going to be losing since they cannot negotiate favourable utility supply contracts as large insurance companies can do.
MEDICA.de: Who will benefit from the fund?
Neubauer: The winners are going to be large insurances and large hospitals regarding utility supply contracts. Doctors and hospitals also benefit from the reform because they can better push through their interests against state than against insurance companies. And also the employer's share of the compulsory health insurance will rise when their employees had previously been insured with a company that required less than 15.5 percent.
MEDICA.de: The fund is supposed to force the insurance companies to economise since it creates more competition. What consequences does this have for the insured people?
Neubauer: Programs for preventing diseases or the supply of innovative may suffer from a lack of money when the companies are being forced to economise strictly. I think that the insurances perceive their clients now in a different way. Before, clients were interesting in terms of their fee, now insurance companies will practise short term care management like an interview via phone asking about food habits or weight for example. This will cause a conflict between insurance companies and doctors since they had been responsible for such measures until now.
MEDICA.de: Will the fee amounting 15.5 percent stay constant?
Neubauer: I think that the government will decide on an increased fee already in 2010. If they do not do so the insurance companies will raise additional fees on their own behalf.
MEDICA.de: Is there an alternative to the health fund?
Neubauer: The patient should carry more responsibility himself. If we use services then we should pay for them. This concerns medical costs as well as additional payments for drugs. It would also be important to consider more thoroughly which treatment is really necessary. A similar principle exists with dentists. If the patient needs a prosthesis the insurance pays a defined contribution that is sufficient for a simple solution. For an expensive one the patients needs to pay the additional costs himself – it is up to him. However, a solid primary care must be provided for every person being insured.
The interview was conducted by Simone Heimann