MYou might think that private health insurance is a thing of the past. The press and social media are full of reports and recommendations on how customers of these companies can switch to statutory health insurance companies in order to avoid the supposedly high premiums. At the same time, there are political efforts to weaken providers on the market in order to attract more money to the financially strapped statutory health insurance (GKV) and to prevent a supposed “two-class medicine”.
The goal not only of the Left party, but also of parts of the government, the SPD and the Greens, continues to be to introduce statutory citizens' insurance for everyone, including civil servants, freelancers, the self-employed and members of parliament. In this model there would be little to no space for private health insurance (PKV).
The latter is getting fire, which makes it all the more surprising that their customer base is not shrinking, but growing. More insured people switch from statutory to private insurance than the other way around. According to information from the FAZ, in 2023 private companies gained more customers than they lost for the first time in twelve years. According to preliminary data, the net increase was only 2,600 people or 0.03 percent, but the downward trend since 2011 appears to have stopped for the time being.
“People trust the stable and future-proof system of private health insurance”
In 2023, more than 8.7 million people had private health insurance, 10.3 percent of the population. According to the National Association of Statutory Health Insurance Funds, there were 74.6 million legally insured people. However, private individuals contribute twice as much to the medical practices' income as their share, more than 20 percent. PKV continued to lose customers every year until 2023. It reached its highest level in 2011 with almost 9 million insured people, and since then there has been a decline of more than 269,000 contributors (minus 3 percent). This corresponds to the population of Mönchengladbach. The last increase from 2010 to 2011 was almost one percent or 81,000 people. In this respect, the current increase is minimal, but it gives the industry confidence.
The PKV Association confirmed the numbers. “This growth proves that people want to take out private insurance, they are looking for security and trust the stable and future-proof system of private health insurance,” said association chairman Thomas Brahm to the FAZ. “This is also a strong signal to politicians of the clear will of the insured respect and give them more freedom of choice,” says Brahm. “Access to private health insurance should not be made more difficult, but must be made easier.” Private providers can also be pleased that they are receiving increased numbers of statutory members and their relatives.
Many deaths
Contrary to what is often assumed, more people with GKV insurance are switching to PKV than the other way around. In 2023, the positive balance was 48,000 people: 164,100 went from GKV to PKV, 116,100 in the opposite direction. The overhang has risen sharply by almost 60 percent since 2022, which is also the best value since 2011. The favorable development for private health insurance has been evident for five years. The relationship had previously been largely balanced for three years. Until 2012, private companies had consistently been ahead; Between 2013 and 2015, however, more insured people temporarily switched from private to statutory providers. To this day, the PKV Association explains its customers' transfer by saying that it is “usually not voluntary”, but rather because of the statutory insurance requirement.
In total, around 242,700 new customers joined the private sector in 2023 (gross access). In addition to those who changed their statutory health insurance, there were also immigrants, newborns and those who were not previously insured. The fact that the net increase in 2023 still amounted to fewer than 3,000 people is due to the many deaths. The “access-relevant” age groups between 30 and 40 are shrinking. All figures are for fully insured people. The volume of additional private insurance also increased in 2023, by 2.5 percent to almost 30 million contracts.
Unlike normal health insurance funds, private ones create aging provisions for each individual possible patient. There were 328.6 billion euros in the pots for this funded process last year, 4.6 percent more than in 2022. Companies are now putting aside almost every third euro in contributions. The sum is twice as high as the annual budget of the Ministry of Labor and Social Affairs, the largest expenditure item in the federal budget. “Every additional privately insured person stabilizes the health system because only in private health insurance are reserves created right from the start for the higher treatment costs in old age,” advertises Brahm. “This demographic provision relieves the burden on the welfare state and, above all, on future generations.”
Meanwhile, the statutory health insurance funds are warning of ever new financial gaps and further rising contributions. In 2024, income would grow by 2.1 percent, but expenses would grow by 5.8 percent to a record of 314 billion euros, said the chairman of the Replacement Fund Association (VDEK), Uwe Klemens, on Wednesday in Berlin.
Instead of constantly increasing contributions, the federal government must increase its subsidies and contribute more to the contributions for citizens' benefit recipients. Klemens' colleague Ulrike Elsner warned against watering down the hospital reform. She accused the clinics of “scaremongering” in order to obtain “ever new financial concessions”. They received around 99 billion euros in 2024, one in every three euros in contributions.
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