German Medical Association

Transcription

1 German Medical Association Federation of the German Chambers of Physicians The Healthcare Insurance System in Germany Bundesärztekammer 2014 Dr. Ramin Parsa-Parsi

2 Basic Features Rhineland- Palatinate Saarland North Rhine- Westphalia Schleswig- Holstein Bremen Lower Saxony Hesse Baden- Württemberg Hamburg Thuringia Mecklenburg Western Pomerania Saxony- Anhalt Bavaria Berlin Brandenburg Saxony Public health is mainly the competence of the 16 federal states Compulsory statutory health insurance for employees (Bismarck Model) Private / public mix of providers and payers Self-governance of physicians and statutory health insurance funds 2

3 Healthcare Expenditure Schleswig- Holstein Bremen Lower Saxony Hamburg Mecklenburg Western Pomerania Berlin Population 80.5 million GDP per capita 32,550 Rhineland- Palatinate Saarland North Rhine- Westphalia Hesse Thuringia Saxony- Anhalt Brandenburg Saxony Expenditure on healthcare: 3,731 per capita ~ 11.5 % of GDP billion per annum Baden- Württemberg Bavaria Data 2012, Source: Statistisches Bundesamt 2014: destatis.de 3

4 Total Healthcare Expenditure Total healthcare expenditure: 300,4 billion Euro Data 2012, Source: Statistisches Bundesamt 2014: destatis.de 4

5 Sources of Finance 57.4% of total healthcare expenditure financed through statutory health insurance (~6.3% of GDP) 13.5% financed by private households, including direct payments and copayments 9.3% financed by private insurance 7.65% financed by long-term care insurance 4.8% financed by public sources Data: 2012, Source: Statistisches Bundesamt 2014: destatis.de 5

6 Statutory Healthcare Expenditure Total expenditure: billion Euro Data 2013, Source: GKV-Spitzenverband 6

7 Statutory Health Insurance Membership & Contributions Contribution rate: standardized since % of gross income (From 2015 depending on insurance 14.6% ) Contributions are shared between SHI insured employees (8.2%) and their employers (7.3%) (From 2015 employers 7.3% and employees 7.3% + possible additional %) SHI membership is mandatory for employees whose gross income does not exceed a certain level ( Versicherungspflichtgrenze ) : 53,550 per year or 4, per month (2014) SHI contributions are not dependent on risk and are proportional to the gross income up to a ceiling ( Beitragsbemessungsgrenze ) of 48,600 per year or 4,050 per month (2014) 7

8 Statutory Health Insurance Membership & Contributions Income assessment ceiling: / annum / month Compulsory insurance ceiling: / annum / month 333 / month Employee contributions (EUR / month) Annual salary (EUR) Data: 2014 Source: BMG

9 Insured Persons Statutory health insurance: ~ 70 million ~ 87% Private health insurance: ~ 9 million ~ 11.2% Data: 2012, Source: GKV Spitzenverband Kennzahlen der gesetzlichen Krankenversicherung 2012; Zahlenbericht der PKV 9

10 Statutory Health Insurance (SHI) 87% of the population are covered by SHI (~70 million people, ~87% mandatory, ~13% voluntary*) Non-earning spouses and children included without any extra charge (~17.3 million) Number of insurers decreased from more than 1,200 in 1993 to about 132 in 2014 Free choice among health insurers SHI funds are obliged to provide membership to any eligible applicant Competitive disadvantages between health insurance funds compensated using morbidity oriented risk-adjustment supplements based on 80 disease groups *Data: 2013 Source: BMG; Rest: GKV Spitzenverband Kennzahlen der gesetzlichen Krankenversicherung März

11 Private Health Insurance 11.2% of the population (self-employed, civil servants and high income earners) privately insured 21.8% of the population has supplementary private health insurance 48 private health insurance companies (risk-oriented premiums) Basic health insurance packages: - Obligation to contract without risk-adjustment of premiums - Benefits package similar to SHI - Highest premium charged must not exceed max. SHI contribution Data: 2010,2012 Source: PKV - Verband der privaten Krankenversicherung, Statistisches Bundesamt 11

12 Healthcare System Money Flow since 2009 Private Health Insurance Employee Standard Premium Basic Private Health Insurance Providers Employer Risk-adjustment Employee Healthcare Fund Lump-sum per member Statutory Health Insurance 12

13 Statutory Health Insurance Consumer Payments Private households contribute ~ 14% to total expenditure on health (including direct payments and co-payments) 10 per day as a hospital inpatient (max. 28 days) Co-payments for prescription medicine (10%; 5-10 ) The limit for copayments is set at 2% of annual gross household income (1% for the chronically ill) 13

14 Long-term Care Insurance Mandatory since 1995 Contribution rate: 2.05% of gross salary - paid equally by employers and employees % for childless - paid by employees Entitlement to long-term care benefits depends on need when care is expected to be required for at least 6 months (assessed in three grades) Currently 2.4 million people receive benefits every month 14 Data: 2012 Source: BMG - Daten des Gesundheitswesens 2013

15 One World One Medical Profession Thank You! 15