360° Next Generation Healthcare
E-Book, Englisch, 400 Seiten
ISBN: 978-3-95466-498-6
Verlag: MWV Medizinisch Wissenschaftliche Verlagsgesellschaft
Format: EPUB
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)
Digital health offers both—a suite of new capabilities and new approaches that unlock health(care) from constraints of time, place, distance and knowledge. It opens up entirely new ways to address and understand people and their health needs. This is how XPOMET© was born, and has been continuously growing as a platform, that is dedicated to innovative trends in medicine and care and at the same time creates a community that promotes cultural change in the healthcare industry.
In 2019, the XPOMET© Medicinale has become an international event to showcase best practice, highlight trends in global healthcare and forecast future developments in health and tech.
The book offers a broad collection of the extensive knowledge of contributors to the XPOMET© Medicinale 2019. International experts share their novel ideas, challenges and achievements in the global healthcare market. The reader is invited to join in the XPOMET© community’s vision and to be inspired by the latest discoveries and technological know-how in healthcare.
Autoren/Hrsg.
Weitere Infos & Material
1
The Future Health Insurance: Social Equality Is Neither Desirable nor Beneficial
Ulrich H. Pieper and Christopher Dickenscheid The German health insurance market is characterized by a dual funding system that consists of a statutory health insurance market and a private health insurance market. The fundamental differences between these two markets result from differing interpretations of the word “fairness”. Within the private health insurance market, the situation is considered to be fair when, over the entire period ensured, the expected insurance premiums are equal to the expected insurance claims (principle of equivalence). Following this principle, people who entail greater costs should pay a higher insurance premium with no regard to the individual’s financial capabilities. Given that the insured must pay the costs that they entail, it is essential to the stability of this market that the insured possess above-average financial capabilities and income (Schradin and Wende 2006, p. 12). In contrast, within the statutory health insurance market, individual healthcare costs have no impact on individual healthcare premiums. Here it is considered to be fair when the premiums are based on the individual’s financial capabilities and people with a higher income pay higher premiums. This guarantees that even people with no income have health insurance. Thus, solidarity is a cornerstone of the statutory health insurance market (Schradin and Wende 2006, p. 4). Solidarity in itself is a social principle that violates basic economic principles. As a result, it brings forth a multitude of inefficiencies that in turn lead to the financial destabilization of the market. Over the past two decades, this effect has been visible within the German statutory health insurance market, as a 70 percent increase in public healthcare costs could only be mitigated by increasing the individual’s insurance premiums (Bundesministerium für Gesundheit [Federal Ministry of Health] 2018). With the ongoing demographic change resulting in an aging society, this trend is likely to continue and the German public healthcare system is in need of reform. Any reform proposal needs to answer two fundamental questions: Firstly, who will be insured? Secondly, what is going to be the basis for the insurance premium calculation? In political discussions, the answer to the first question is often the unification of the two health insurance markets. This would integrate the rather wealthy insured people of the private health insurance market into the statutory health insurance system and therefore increase solidarity. Furthermore, this would lighten the financial burden of insurance premiums for the working class that is currently put on the middle class. Overall, this would increase solidarity (at least temporarily), stabilize the market financially and, therefore, would be beneficial to society. The answer to the second question is rather complex and has a great impact on the financial stability of the resulting system. Fortunately, these problems are for the most part not unique to the German health insurance system. Some of our European neighbors have faced similar problems, therefore have had to answer similar questions in the past and it is worth taking a look at how they have chosen to handle them. Good examples are the Netherlands and Switzerland. Both countries have chosen to reform their healthcare system in the past 25 years. They introduced a basic health insurance system that is mandatory for every citizen. This basic health insurance, in both cases, covers the inpatient and outpatient care as well as the prenatal care. Should an individual’s need or desire for health insurance exceed the coverage provided by the basic insurance, s/he may purchase private supplementary insurance. In effect, the Netherlands and Switzerland both introduced a dual health insurance system. However, they implemented vastly different financing structures for their basic health insurance. Health insurance system in the Netherlands Within the Dutch system (see fig. 1), the healthcare costs are financed equally by income-dependent and non-income-dependent premiums (Greß et al. 2006, p. 16). The income-dependent premium is paid by the employer and is calculated as a percentage of the individual’s gross monthly salary. The non-income-dependent premiums are paid by the insured directly to the insurer in the form of a capitation fee. In addition, the policyholders have to pay a yearly deductible. Since the non-income-dependent premium and the deductible create a disproportionate financial burden for low-income households, financial support in the form of transfer payments is provided by the Dutch government (Arentz 2018, p. 8). Additionally, the government also pays all premiums for minors under the age of 18. These payments for minors as well as the income-dependent premiums are not paid directly to the insurer but to a central fund instead. From here each insurer is assigned a certain amount as compensation based on the risk structure of the people they insure. Fig. 1Financing structure in the Netherlands (based on Ginneken et al. 2006, p. 12) Health insurance system in Switzerland Within the Swiss basic healthcare system (see fig. 2), the insured contribute to financing the healthcare costs in four ways (Spycher 2004, p. 25): by paying a health insurance premium in the form of a capitation fee, by paying roughly ten percent of their individual healthcare cost as co-insurance, by paying a yearly deductible, and in the form of tax payments. It is worth mentioning that the premiums, co-insurance, and the deductibles are all non-income-dependent payments. Even the tax payments can only be considered as income-dependent to a small extent, which indicates the overall low level of solidarity within the Swiss health insurance system. The Swiss Government provides financial aid for people in low-income households, who may otherwise struggle to pay for their basic health insurance (Gerlinger 2003, p. 8). Additionally, tax payments are used to subsidize the construction and operation of hospitals. Roughly two-thirds of the healthcare costs are financed by non-income-dependent premiums, the remainder is government-funded. Fig. 2Financing structure in Switzerland (based on Spycher 2004, p. 23) Fig. 3Healthcare costs as a share of GDP (OECD 2019) Both countries implemented a dual insurance system with mandatory basic health insurance and with similar insurance coverage but chose completely different financing structures, resulting in different levels of solidarity and healthcare expenses within the two systems. Even after factoring in the high costs in Switzerland and looking at healthcare expenditures as a share of the national GDP, the Swiss healthcare system still entails much greater costs than the Dutch system (see fig. 3). Since this is a rather brief and shallow comparison, it is not possible to derive an unequivocal correlation between the level of solidarity and financial stability of a system, but it does indicate a positive correlation between them. One could conclude that increasing the level of solidarity has a positive impact on the financial stability of the system and is beneficial to society. In other words: The marginal utility for solidarity would be positive. In a theoretical healthcare system without any financial solidarity, a large percentage of the population would not be able to afford any form of health insurance, so introducing any form of solidarity into the system would be beneficial to society overall. This coincides with the correlation found in the comparison of the Dutch and Swiss healthcare systems, however only for low levels of solidarity. If this correlation remains unchanged for any level of solidarity, it would imply that it is beneficial to society and the financial stability of the system to continuously increase solidarity until absolute financial solidarity is achieved. In consequence, there wouldn’t be a correlation between the income or financial capabilities of an individual and the quality of healthcare s/he receives. This can only be achieved in one of two ways: Either purchasing private supplementary insurance will be forbidden, thereby limiting every citizen to the insurance coverage provided by the statutory health insurance. Or by broadening the insurance coverage of the statutory health insurance so that it includes every possible current and future treatment, making private supplementary insurance redundant. Newly developed medical treatments are often more effective in treating a disease, but are also more expensive. Limiting every citizen to statutory health insurance would prevent such new treatments from being offered, lowering the overall quality of healthcare. Additionally, this reduces or destroys any incentives for further innovation or investment in the healthcare market. The German healthcare market, for...
