D.he financing of statutory health insurance is like a roller coaster ride in Corona times. After the cash registers were able to look forward to a good surplus in the first half of the year, according to information from the FAZ, they ran a monster deficit of more than 3 billion euros in the third quarter. According to preliminary figures, things looked worst at the general local health insurance funds with minus 1.4 billion euros, followed by the substitute funds with minus 1.2 billion euros.
At the guild health insurance funds, the expenditure exceeded the income by more than 200 million euros. In the company health insurance funds, the underfunding was 150 million euros, in the miners’ union it was 52 million euros. The minus in the statutory health insurance (GKV) was a total of almost sixteen times as large as a year earlier, when it had amounted to 193 million euros.
The more than 100 German health insurances had closed the first half of 2020 with a big plus of almost 1.3 billion euros: because expensive operations and other treatments were postponed during the corona pandemic and because significantly fewer patients than usual see a doctor had married to the hospitals, to the physiotherapist or to rehabilitation.
A high surplus improves the balance sheet
The spring surplus is also the reason why the nine-month figure was less catastrophic than the third quarter. And yet the deficit of 1.7 billion euros accumulated in the first three quarters is almost two and a half times as high as that between January and September 2019.
Martin Litsch, the chairman of the board of the AOK-Bundesverband, spoke in view of the financial development of “Corona-related violent fluctuations in the course of the year so far”. The result is “now back into the red as expected”. That has to do with the normalization of treatments and operations after the first lockdown, with catch-up effects, but also with the so-called Insurance Relief Act. Health Minister Jens Spahn (CDU) wants to get the GKV to gradually reduce its billions in reserves. This happens because the additional contributions to the health insurance are “cheap, but do not cover expenses,” Litsch told the FAZ. In the middle of the year, the cash reserves amounted to almost 21 billion euros.
Nonetheless, the quarterly result is only a “snapshot of extraordinary times”, Litsch believes that the informative value is limited: “We can still only partially predict when and how much the pandemic costs will have an impact,” said the association head. “What is clear, however, is that we will end this year with a minus and that the big end for statutory health insurance is yet to come.”
Reserves cannot fill the financial gap
Litsch complained that this is due to the fact that in 2021 the health insurances “in addition to Corona will also have the full financial impact of Spahn’s laws”. “In order to intercept this in the short term and to plug a financial gap of more than 16 billion euros, among other things, the reserves of the coffers will be burned before the federal election.” For 2022, Litsch expects a shortfall of 17 billion euros in the statutory health insurance.
“This hole can no longer be filled with cash reserves,” Litsch pointed out. “With the reserves, the design leeway for better health care has also been used up. Political concepts of how clever countermeasures should be taken are currently in vain. “
Litsch did not comment on the insurance premiums. However, it has already been decided that the average additional contributions will increase from 1.1 to 1.3 percent in 2021. The National Association of Statutory Health Insurance Funds actually considers 1.4 percent to be necessary. It is generally expected that the tariffs will continue to rise – but only after the federal election and after the end of the “social guarantee” with which the grand coalition promised to limit social security contributions to a maximum of 40 percent.
Bettina am Orde, the managing director of the Knappschaft, also speaks of “major financial problems”. “Not only the Corona crisis, but also the legislation from pre-Corona times put a significant strain on the quarterly result.” Per insured person, the miners’ benefit expenses increased by almost 5 percent compared to the previous year. While the costs for preventive care, early diagnosis, rehabilitation and dentures have fallen significantly, the expenses for vaccinations and sick pay have increased by more than 20 percent.
Ulrike Elsner, the chairwoman of the board of the VDEK Substitute Fund Association, sees insurance companies under “considerable financial and additional premium pressure”. This was only temporarily moderated by the decline in expenditure caused by the pandemic in the second quarter. Elsner considers the skimming of 8 billion euros from the cash reserves to plug the financial hole in the coming year to be understandable. However, she expects from politics “that such an encroachment on the financial autonomy of self-government will not be repeated.”
The information provided by the cash associations to the FAZ is not entirely complete, as some individual companies have not yet reported their figures and the data from the – albeit small – agricultural funds are completely missing. The Federal Ministry of Health under department head Spahn does not comment on the preliminary results.