Beitragssatz, Kassenwettbewerb und Gesundheitsreform / Premium Rates, Competition Among Health Insurance Funds and the Health Care Reform 2007

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Hanfried H. Andersen ◽  
Markus M. Grabka ◽  
Johannes Schwarze
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Reform ◽  
Statutory Health Insurance ◽  
New Products ◽  
Panel Study ◽  
Multinomial Logit Model ◽  
Insurance Funds ◽  
Premium Rates ◽  
Health Insurance Funds

SummaryThe premium rates paid for statutory health insurance in Germany play a key role in the competition among health care funds. With the most recent health care reform (GKV-Wettbewerbsstärkungsgesetz GKV-WSG), a range of new products have been introduced that could erode the advantageous selling proposition of the premium rates. In addition to the pure monetary incentive to change health insurance provider, the new products include aspects that are becoming increasingly important to insured persons, such as the assessment of their own morbidity and the level and quality of health care provision. We find that current morbidity, experiences in morbidity, and expectations about morbidity will gain in importance when choosing health care provider.Using micro-data for the years 1999 to 2004 from the German Socio-Economic Panel study (SOEP), we investigate the willingness to change health provider in a multivariate setting. The SOEP data will be matched with register information about premium rates of all statutory health insurance funds in Germany. Applying a multinomial logit model, we show that there are two prototypes of insured people who change funds. The characteristics of those who changed funds can be used to evaluate the future developments in statutory health insurance in Germany, assuming that customer mobility will continue to increase.

scholarly journals On the slow implementation of pilot projects: Suspected causes from the perspective of statutory health insurance funds / Zur zögerlichen Umsetzung von Modellvorhaben: vermutete Ursachen aus Sicht der gesetzlichen Krankenkassen

2018 ◽  
Vol 5 (1) ◽  
pp. 64-71
Author(s):  
Michael Wessels ◽  
Dorith Geuen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Statutory Health Insurance ◽  
Insurance Companies ◽  
Care Providers ◽  
Pilot Projects ◽  
Insurance Funds ◽  
Health Insurance Companies ◽  
The Law ◽  
Health Insurance Funds

Abstract Background The system of nursing care in Germany is currently changing. For years, a further development of cooperation in the health care sector has been discussed. And thus a change in the distribution of tasks between health care professions. In 2008, the legislature introduced the introduction of pilot projects for the transfer of medicinal tasks to nurses according to § 63 para. 3c Social Code V. The implementation is very sluggish. The aim of the study was to analyze the reasons for this sluggish implementation from the perspective of the statutory health insurance funds. Methods Quantitative survey of all statutory health insurance funds (n=124) in Germany. Results To ensure supply, 94 % of health insurance companies consider the transfer of medical tasks to non-medical care providers as a sensible approach. Also 96 % consider this to be very important in order to ensure care. Although 96 % of health insurance funds support the implementation of pilot projects, only 8 % are in fact involved in such contracts; 71 % do not plan own pilot projects for the future. In the view of the statutory health insurance funds, legal obstacles (90 %), resistance by medical representatives (84 %), unresolved financing (74 %) and liability issues (70 %) as well as non-applicable regulations in G-BA-directive (79 %) and the law (85 %). Less than half (46 %) of the health insurance companies suspect high costs causing the slow implementation. Discussion The amendments adopted by the legislature in the current reform of the law on care professions can be described as appropriate; in particular the fact that statutory health insurance funds should implement and carry out appropriate pilot projects by 31 December 2020.

Back to the future: Polish health care reform

2003 ◽  
Vol 36 (4) ◽  
pp. 385-403 ◽  
Author(s):  
Rachel Filinson ◽  
Piotr Chmielewski ◽  
Darek Niklas
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Workers ◽  
Universal Health Insurance ◽  
Care Workers ◽  
Insurance Funds ◽  
Physician Resistance ◽  
Polish Government ◽  
Health Insurance Funds ◽  
Universal Health

In January 1999, the Polish government implemented a new law reorganizing the health care in the country. This paper includes an outline of the changes, the main impact of which consisted of introduction of universal health insurance administered by Health Insurance Funds (‘‘Kasy Chorych’’). In June 2001 and 2002, a survey of insurance administrators and health care workers provided data concerning the reception of the new system, the perceived inadequacies, and the postulated changes. The intended objective of privatization of health provisions appears as remote as it was before the changes. The major obstacles are identified as political hurdles, physician resistance, and continued dependence on state allocations.

scholarly journals What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Expenditures ◽  
Advantages And Disadvantages ◽  
Care Services ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

scholarly journals Digitization in the German Health Care System - An Analysis of the Status Quo Using the Example of the Dental Sector

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Christian Maier ◽  
Tizian Juschkat
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Data Processing ◽  
Healthcare Industry ◽  
Electronic Data ◽  
German Health Care System ◽  
German Health ◽  
Insurance Funds ◽  
Health Insurance Funds ◽  
Cost Plan

According to the Federal Ministry of Economics and Energy, the German healthcare industry is growing faster than the economy as a whole but is regularly far behind compared to the rate of digitalization. Nonetheless, the healthcare industry offers great potential for digital applications. The brief overview at hand uses the example of treatment and cost plans in the dental field to illustrate the state of digitalization in the German health care system. The primary goal is to examine whether it is possible to transfer the principle of electronic data medium exchange for hospital settlements and the associated electronic data processing to the transmission of treatment and cost plans in the dental field. Anselstetter's (1984) expertise is fundamentally used to evaluate the benefits of electronic data processing and to a treatment and cost plan under critical evaluation. In order to determine relevant benefit effects for health insurance funds and dentists, a transfer and processing form of the treatment and cost plan is used based on a generated model. Applying this model can assist health insurance funds to identify effects regarding time, personnel reduction, and more efficient use of existing personnel structures. It also provides health insurance companies and dentists with an overview of the possible benefits of electronic data transmission and processing. Nonetheless, one of the problems is that it is not possible to calculate the expected costs due to the lack of empirical examinations. Consequently, a detailed cost- benefit evaluation of an electronic transmission and processing of the treatment and cost plans is unfeasible.

scholarly journals What Kinds of Advantages and Disadvantages Is May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Financing ◽  
Health Care Expenditures ◽  
Negative Consequences ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Health Insurance Funds

Abstract Background: Fragmentation in health insurance system is a major concern in health financing. One possible solution to overcome problems resulting from fragmentation is combining risk pools together. This study aims to realize the potential advantages and disadvantages of merging health insurance funds. Methods: In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. The documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the qualitative data. Results: The results of this study indicated that there are diverse positive and negative consequences for merging health insurance funds in Iran. These are categorized into seven categories, including governance/stewardship, financing, population, basic benefit package, structure, operational procedures, and interaction with providers. Control of total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database and reducing fraud and controlling the volume of health care services provided by the providers; interaction of hospitals with single insurance with a single set of instructions for contracting, claiming review and reimbursement; reducing administrative and overhead costs were among the main benefits of merging mentioned by interviewees. The following drawbacks were raised as well: the unwillingness of the social security organization to collect insurance premiums from private workers actively as before; increasing dissatisfaction among population groups enjoying generous basic benefits package at the current situation; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on the providers in case of delay in reimbursement by the single-payer. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

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