Terminating stagnation - redesigning the system

 

"Only through a new synthesis of competition with a solidarity-based insurance system can the future problems of the German health care system be solved. With our suggestions, we would like to lay the cornerstone for a liberal health care system based on the solidarity principle that is sustainable in the future," said Prof. Dr. Bernhard Scheuble, chairman of the Association of Research-based Pharmaceutical Companies, during the presentation of the VFA reform concept "Self-determination, Solidarity, Competition - How to make the health care system future-proof."

"The existing structures and control instruments are no longer effective or efficient," Scheuble critically remarked. "Quality deficits in medical care are increasingly becoming the norm in day-to-day therapy." While patients and insured individuals are denied any true selection and design options, the contribution rates of statutory health insurance are continuing their upward spiral.

"With our concept, we would like to advance the urgently necessary innovations for our health care system," the VFA chairman emphasized. "We want to set up a supporting pillar for a modern welfare state." According to Scheuble, this includes a strengthening of the solidarity principle, more freedom to choose based on self-determination and self-responsibility, the opportunity of quality-oriented competition and a redesign of the financing system.

The VFA demands compulsory health insurance for the general public as a constitutive element of a new competitive system in the health care sector. "Nobody must be without health insurance coverage. Taking out health insurance must be mandatory for all citizens to avoid health care gaps in the competition," Scheuble underscored. The VFA reform concept includes plans to focus the social redistribution tasks on the government and the tax system. Not just SHI contributors but all tax payers should finance the redistribution tasks that are necessary from a political standpoint. Therefore, all services not related to insurance must be separated from the statutory health insurance system.

Apart from the solidarity principle, the VFA wants to strengthen self-determination and self-responsibility. "Insured individuals must be able to customize their insurance coverage. Each person must have an opportunity to make a choice between health insurance forms and services," Scheuble said. At the same time, selection offers for the insured patients require an intensification of the competition between health insurers and service providers: "Only a functioning competition between health insurance funds and service providers can ensure high-quality health care for all patients."

In addition, the VFA believes that the existing financing system must be reformed. Scheuble: "The wage-related contribution assessment of statutory health insurance is outdated. Especially if insured individuals are to be granted more freedom of choice in the future, a turn toward more appropriate insurance contributions is indispensable."

The VFA chairman demanded that the course for a free market-oriented health care system be set as part of the health care reform 2003. The VFA proposes the following initial steps:

The role of patients must be strengthened: A modern health policy relies on emancipated citizens. As a result, more information and co-determination for patients are required.

The service catalog must become differentiated: Especially for serious diseases, insured patients desire modern and efficient health care services. They must be able to decide individually with regard to the kind, extent and provider of health care services. The insured persons must have an opportunity to compile their insurance coverage based on their individual catalog of preferences.

The cost transparency must be increased: All individuals insured in statutory health insurance should have at least the opportunity to select between non-cash benefits and cost reimbursement. Only if they know the costs for the individual health care offerings will they be able to assume stronger self-responsibility and make use of their right to choose.

Contractual freedom must be extended: Firm, uniform assessments and government or self-administration regulations should be replaced by decentralized negotiation solutions and remuneration and reimbursement schemes of the individual health insurance funds.

The employer's contribution must be converted into wages: To increase the transparency of financing in the system, the employer's contribution should be converted into wages and contributions should be billed entirely to the insured individuals.

Shifting maneuvers must come to an end: Non-insurance services must be appropriately financed based on separate social security legislation or the respective social security institutions in the form of regular contribution payments to the health insurance funds.

Download of the brochure "Das Gesundheitssystem zukunftsfähig machen - Konzept zur Reform des Gesundheitswesens in Deutschland": see right column.

Download: English version of the VFA reform concept