SHI finances: New deficit not ruled out

With the finances of the statutory health insurance companies, things are looking better than expected. In 2022, a positive result of 451 million euros was achieved, in the health fund (to which the contributions of the insured as well as state compensation payments flow, in order to then be distributed to the coffers) there was a sum of 4.273 billion euros at the end of the year. The financial reserves totaled 22.3 billion euros. The income per member had increased by a total of 4.37 percent due to contributions and additional contributions, but the total expenditure per insured person was “only” by 4.09 percent. Although benefit expenditure rose in all areas, the rise in pharmaceuticals and medical treatment was lower than expected. Doris Pfeiffer, Chair of the Board of the Central Association of Statutory Health Insurance (SV GKV), gave these figures to journalists at the end of last week.

However, the prospects are only positive at first. Because the structural deficits in the finances of the statutory funds have not yet been eliminated, let alone that there would be a consensus on the way out of the deficit economy. The National Association of Statutory Health Insurance Funds has clear ideas about those financial imbalances that should be eliminated very quickly by the legislature: the federal government should contribute more to non-insurance-related services such as pregnancy and maternal care. The lump sums of the federal government for the health care of citizens benefit recipients would have to be increased. If these expenses were fully covered, the funds would have around ten billion euros more available, and the regular contributors would not have to help finance it. Neither the bill nor the demand are new. According to the coalition agreement, the problem should be solved in this legislative period, but it has not yet been on the traffic light agenda.

Actually, the Ministry of Health was supposed to make recommendations for “stable, reliable and solidarity-based financing”; the deadline was May 31, 2023. But here, too, there was no answer. In view of how difficult it was recently to legislate health policy at all, the representatives of the central association are not very hopeful of viable solutions.

For the year 2023 was one Funding gap of 17 billion euros expected, but this was closed with one-off measures, including reserves of the health insurance funds and the health fund were reduced by a total of 7.2 billion euros. The insured had to do it too: The actual additional contribution rose from 1.36 percent to 1.51 percent, which amounts to around 2.5 billion euros.

From the current perspective, it cannot be ruled out that the cash registers will again be in the red in 2024: According to Pfeiffer, this could be up to seven billion euros. “Without further measures, the additional contribution rates would have to rise by 0.2 to 0.4 points,” says the economist. Good cash receipts could also have a dampening effect here, thanks to stable employment and high wage agreements.

For the National Association of Statutory Health Insurance Funds, one of the most urgent reforms is the reorientation of the hospital sector: The needs of the population are decisive here, according to the latest results of the federal-state agreement on the subject. The latter can cause irritation, it seems as if the different levels of care preferred by Health Minister Karl Lauterbach cannot be achieved with some of the federal states. According to the current status of the debate, however, it would remain with the service groups for care priorities, analogous to the reform that has already begun in North Rhine-Westphalia.

The greatest conflicts, however, repeatedly appear in the reform debate at the point of how many of the existing hospitals are necessary, how many would have to close or be converted into other facilities. The National Association of Statutory Health Insurance Funds also stops here a concentration for necessary. “With around 1250 clinics that already exist, good care would be secured in Germany,” said Stefanie Stoff-Ahnis, board member. That would be more than 400 fewer than currently. From the patient’s point of view, it’s no use just being in a bad clinic quickly. A “nationally uniform planning language” is needed for quality and needs. The GKV model specifically mentions the numbers of certain types of hospitals that require care: These include 422 clinics with “extended or comprehensive emergency care”, 358 with an emergency level and an accessibility within 30 minutes driving time. There could also be 272 larger specialist hospitals and 64 specialized locations such as children’s clinics or trauma centers. Another 131 hospitals would be needed to ensure regional care.