As health care reform legislative intervention in the framework of health insurance are referred to in Germany. These reforms were in the last decades mostly in stabilizing the contribution rate and were usually associated with restrictions on the benefits, increases in co-payments to the otherwise self-management underlying insurance and changes in the payment of the service. Post changes affect the wage costs of employers and the living expenses of the insured. Historically, however, such reforms were often an extension of benefits or coverage for larger populations result.
The goal of most health reform is a short-term change in the financing of medical services. The promotion of preventive approaches to preventing disease-related costs played a smaller role in recent health reforms.
Individual reforms
Health reforms 1976-1983
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1983 Budget Support Act (now 2 DM (1 euro) per drug, of the day in the hospital cost 5 DM (2.50 €) per day - no more than DM 70 (36 euros), with health insurance of pensioners now have pensions, pensions and next result obtained earnings from self-employment contributions, pay the contributions on pensions / pensions equal recipients and Paying Agent
Cost Containment Amendment Act 1982 (now DM 1.50 (75 cents) per medication for eyeglasses and remedies such as massage, bath DM 4 (2 euros) per prescription. Too for glasses around DM 4 (2 euros) were due)
1977 cost containment law (including drug-limits and performance constraints, petty drugs are not paid, payments per Pharmaceuticals, bandages and remedies are introduced. Previously, the insured a maximum fee of DM 2.50 (1.25 EUR) per prescription now 1 DM (50 cents) per drug., the ceiling of own participation in dentures from $ 500 (256 euros) has been deleted.) Concerted Action in Health Care was established, where the parties should agree in public health measures to control costs yourself. [1 ]
1976 reduction of the contribution of pension funds for health insurance for pensioners from 17 to 11 percent. A pension increase would not have been possible without this measure in the general election in 1976. The then Federal Minister responsible Herbert Ehrenberg (SPD), was accused by the opposition of the pension therefore lie.
The health reform in 1989
With the health care reform law "GRG" under Norbert Blum (CDU), the statutory health insurance from the 2nd was Book of the Reich Insurance Code (RVO) from 1 January 1989 in the Fifth Book of the Social Code (SGB V) applied. Other changes included the introduction of a "negative list" of the Federal Ministry judged to be uneconomical drugs, the introduction of fixed amounts of drugs (at higher prices, the patient must take the difference) and a higher fee for prescription drugs. For non-price-controlled medicines of the future impact was 3.00 instead of 2.00 DM DM clinic payment has been doubled. A significant excess (between 40 and 50% of the cost) for dentures was introduced.
Also, workers were now free insurance when they exceeded the annual income limit, which took the place of the previous annual earnings limit, previously this was only true for employees. The differentiation between workers and employees was repealed. The possibility of voluntary insurance was largely restricted. For workers and employees a so-called solidarity model was provided, after which both groups of workers did not have the right to join a replacement fund, as they were with their remuneration does not exceed DM 3600 (1841 euros) and uninsured for at least 5 years with a primary office. In the power range extended screening tests and performances of a home care assistance for care were incorporated. The cost of dentures were only up 50 percent over the orthodontic treatment only in the form of a reimbursement of up to 75 percent of the health insurance and only if the treatment has been successfully completed. The death benefit of health insurance was cut. [2]
Health reforms 1993-2002
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It lists dates of the changes:
2002 Contribution Rate Security Act "BSSichG" by Ulla Schmidt (SPD) (including reduction of the death benefit, further tightening of budgets for hospitals and doctor's fees)
2002 Act to limit drug spending of the statutory health insurance (pharmaceutical expenditure limitation law - AABG)
2001 Act for the relief of medicines and remedies budget (Budget Medicines Redemption Law - ABAG)
2000 SHI health reform (including budget tightening for doctor's fees, medicines and hospitals. Recourse for exceeding the budget)
1999 SHI Solidarity Strengthening Act (SPD-Green) (including the reintroduction of the budgets for doctors' fees, hospitals, medicines and remedies budgets. Too, the post-1978 born again had the right to supply dentures., The co-payments for medicines and remedies have been reduced.)
. SHI Restructuring legislation in 1997 under Horst Seehofer (CSU) (inter alia, further increased co-payments for medicines and remedies from 4.50 to 6.50 euros a hospital day cost 7 euros - "Hospital emergency tax", rehabilitations up to 12.50 euros. In addition, the cash grant for dentures at all births from 1979 Increased capital investment in transport costs) has been deleted from exceptions.
1996 Contribution Relief Act (including cancellation of assistance for dentures for insured persons born after 31 December 1978 (in force until 1998), no refunds on eyeglasses, increased co-payments for drugs, benefit cuts and payment increases for treatments, reduction of sick pay)
1993 Health Care Structure Act, also known as "Lahnstein compromise" between Horst Seehofer (CSU) and Rudolf Dressler (SPD) (including free choice of health insurance as of 1997 for all insured introduction of budgeting, increased co-payments for medications, co-payments for dentures and remedies and increases for hospital treatment. Amounts of drugs were graded according to package size)
The health reform in 2003
As part of the implementation of Agenda 2010, the government and the opposition agreed (SPD / Greens and the CDU / CSU, FDP) in the summer of 2003 to the "Act to modernize the statutory health insurance" (abbreviated SHI Modernization Act, GMG).
Changes from 1 Effective January 2004, include the deletion of the maternity and death benefits and the introduction of a so-called consultation fee. The aim of the reform was due in the next few years the average contribution for health insurance to about 13% of income (on 1 July 2003, it stood at 14.4 percent). Thus, the wage costs should be reduced. However, "further decisions on the sustainable financing of the SHI must be made" in the long term in the opinion of the Federal Government.
For the first a dental scheme was planned after from 1 January 2005 alone, an additional income of the insured independent contribution should be levied. From 2006, the sickness should also be financed without employer involvement. On 1 October 2004, the Bundestag decided by the votes of the red-green coalition, that the contribution of the public health insurance is first lowered from July 2005 to 0.45 per cent for employers and employees, but at the same time, workers must pay a special contribution of 0.9 percent . The parity of contribution was thus canceled.
In addition to the targeting of financial relief to employers elements approaches to structural changes are evident. Both the duality principle (division of social security contributions on employees and employers) as well as the principle of solidarity (economically stronger and healthy pay more than economically weaker and sick) are weakened.
The health reform 2004
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With the law on the modernization of public health insurance under Ulla Schmidt (SPD), the government increased the self-involvement of the patient comprising: 10 EUR practice fee per quarter, 10 percent co-payment for drugs and supplies - between five and ten euros, limited 10 euros per hospital to 28 days. Non-prescription drugs, travel costs (outpatient treatment), and goggles must be fully borne by the patient, maternity and death benefits are deleted. The upper load limit for payments of two percent since then (for the chronically ill one percent) of the annual gross income)
The 2007 health reform
Coalition agreement
The coalition agreement between the CDU, CSU and SPD of 11 November 2005, the coalition parties agreed on a reform of the health insurance, which should take into account the rising cost of health care by medical progress and demographic change into account. The aim was to formulate a compromise [3] between the formulated during the election campaign for the parliamentary elections in 2005, the health premium models of the Union parties and the solidarity citizen's insurance of the SPD.
Thus, "a comprehensive concept for the future in the field of public health insurance in 2006 to develop, which is also applied on keeping the contributions to statutory health insurance at least stable and to reduce as possible."'ll Specifically, the parties agreed that the health system in terms of the interaction of private health insurance and public health insurance should receive an enhanced competitive position. The so-called health care summit on 29 March 2006, which was attended by leaders of the coalition parties, including Angela Merkel, Edmund Stoiber, Volker Kauder, Peter Ramsauer, Franz Muentefering, Peter Struck and Heil, was adjourned without concrete results. A compromise was seen by the SPD and CDU in advance of the negotiations to be essential for the survival of the coalition. Federal Health Minister Ulla Schmidt was not present at the talks, the former SPD chairman Matthias place was missing because of a hearing loss.
Cornerstones for health care reform
On 3 July 2006 agreed the party leaders of the CDU, CSU and SPD on the key points for health care reform [4].
Ingmar Kumpmann, the Institute of Economic Research, summarizes the core of the federal government plans for health care reform in 2007 as follows:
The health insurance increase their wage-related contribution rates in 2007 by 0.5 percentage points, which is expected to bring in additional revenue of approximately EUR 5 billion. The increase applies to employees and employers each half. The contribution rate that reached an average of 14.7% of gross salary health insurance. Of which 6.9 percentage points are paid by the employer, the employee contribution also includes the 2005 launch of special contribution of 0.9% and will therefore be 7.8 percentage points on average. (The legislature was then relieve with this special contribution employers of wage labor costs and promised thereby encourage the creation of jobs.) The original statement of the special charge is to cover the personal life of risk of each individual, dentures and sickness, was dropped again quickly. Because this argument would have all pensioners who yes are no longer entitled to sick pay, at least have to get rid of a portion of the Fund contribution.
The tax-funded subsidy for health insurance which is lowered in 2007 to 2.7 billion euros to 1.5 billion euros and should be dropped according to the coalition agreement from 2008, but is now maintained. 1.5 billion euros are planned for 2008 and 3 billion euros for 2009. Long-term plan to increase the tax subsidy. Through him the free co-insurance of children is to be financed in the statutory health insurance in the future.
The wage-based contributions from employers and employees and the subsidy from tax revenues are to be distributed in a future health under the health insurance fund. In addition, a supplementary additional contribution to the health insurance companies can charge directly from their respective insured. It is optional for them to collect this additional contribution as a percentage of income or capitation. The additional contribution is capped at 1% of income. Funds that receive less than they spend money from the health fund, its members can also submit posts instead.
The current limitation to a fixed remuneration of physicians overall budget is released. Instead, the fee will be converted to flat rates per service, per illness or per patient treated, which are defined in a uniform nationwide euro fee schedule. Focus, the remuneration for complexes of related services. In excess of certain amounts of power while a doctor is allowed to charge only gradually lower (abgestaffelte) prices.
The pharmacies have to pay a higher discount (€ 2.30) than before (2.00 EUR) per prescription medicine to the public health insurance. This represents a saving of around 180 million euros annually.
In private health insurance (PHI) insured should be able to take the retirement provisions, which were formed during the previous insurance for them, the new insurance to the extent with a change of insurance in the future, they would have accumulated if they insured the base rate was would. So far, the insured lose this built up from their contributions in PHI capital stocks when they switch to another insurance company.
Principle: "Outpatient held stationary '
Compulsory insurance of all Germans agreed. Then in addition to the statutory health insurance must offer a uniform basic tariff with a minimum of services and private health insurance. The rejection of an application for admission to the base rate can not be due to a health risk assessment.
The tax financing of the fund is criticized because health care costs losing transparency and, above all, because the income of the strongest lobby fights against the expansion of solidarity on their full income for health insurance purposes. Was possibly illegal, that privately insured as before to pay the premiums for themselves and for each of your child fully, but in addition pay the tax to other insurance companies, from which place no benefits. There is also criticism that the fund creates new costs for the administration itself. See also Health Fund.
Agreement in the coalition committee on 5 October 2006
After months of discussions and expert groups in the coalition committee, the grand coalition agreed on the following modifications of the vertices:
The new health fund will be introduced from 2009.
If the income of health insurance from the Health Fund should be insufficient, the health insurance will have the opportunity to raise an additional contribution. It is to apply an excessive demand clause under which the additional contribution shall not exceed one percent of household income. However, the compromise also provides that additional contributions up to eight euro may also be charged on a monthly 'without' income test. See a lot of media representatives in the shift to 2009 - so close at the next federal election - an indication that the idea of health fund has little chance of survival.
The coalition committee agreed yet in other areas:
All citizens who currently have no insurance coverage, the return to health insurance must be enabled.
Instead of seven leading associations of statutory health insurance there will be only one in the future.
The statutory insurance get more freedom in the contractual arrangements with service providers.
Spending on hospital care will be further limited. Some prime ministers have to formulate clear reservations.
Adoption of the 2007 health reform
On 2 February 2007, the Health Care Reform (Act to Strengthen Competition Law) was adopted in Berlin in the German Bundestag. With 378 votes in favor of the controversial federal health reform approved. The opposition voted unanimously against it, even with their 23 deputies of the CDU / CSU and the SPD 20 MPs. [5]. On 16 February gave its approval of the Bundesrat. On 26 March was the law signed by President Horst Köhler. The new health insurance occurred mainly on 1 April 2007 force.
Contents of the 2007 health reform
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The first duty of citizens to take out health insurance, provided that no other health care coverage exists. (From 1 January 2009 and 1 April 2007)
a reform of the supply structure and organization of the cash
Introduction of legal entitlement to rehabilitation by the statutory health insurance
Introduction of legal entitlement to nursing home care in residential communities and similar new forms of living
Improvement of palliative care
Opening the hospitals for outpatient treatment of people who suffer from serious or rare diseases
Vaccinations and treatments are standard services provided by public health insurance
Introduction of a cost-benefit assessment of drugs by the Institute for Quality and Efficiency in Health Care
Introduction of the requirement for a second opinion for the regulation of special, highly innovative drugs
Introduction of optional tariffs
Creation of a Central Federal Association to replace the current seven umbrella organizations, but in fact continue to exist in the form of civil partnerships (GbR)
Facilitation of cross-border mergers health insurance funds
Introducing advanced options for health insurance to agree with the manufacturers of medicines cheaper prices (discount contracts)
Introduction of the "suspension of entitlement to benefits" for non-payment of contributions; occurs only in acute diseases the health insurance an even, but does not extend to the family members of insured
a reform of the private health insurance
The insured in the private health insurance can be from 1 January 2009 to take their aging provisions for a transfer within the PHI to the extent that they have accumulated if they had been insured in the base fare.
a reform of the financing order
with the introduction of the Health Fund, a uniform contribution rate from 1 January 2009, the SHI (initially 15.5%, while 14.9% of the economic crisis in 2009 and again from 2011 15.5%), with good economize insurance premiums to make repayments and can raise bad economize additional contributions. Critique of the representation of the BMG: Should the risk equalization between funds with mostly poor, sick and elderly and those with predominantly affluent, younger and healthier patients prove to be insufficient, the additional contribution, however, has little to do with whether the cash well wirtschaftet , but solely by means of which it has insured structure. Not be underestimated in this context is the possibility of insolvency newly created public health insurance.
The health reform in 2011
With the first January 2011 came into force health care reform to the annual income limit was reduced to 450 € 49,500 € per year. Another bonus for employees who want to switch from the statutory to private health insurance, is the abolition of the three-year period. From this point, the one-year period applies, which means that employees must demonstrate at least one year more than 49,500 euros gross income to obtain the freedom of choice.
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