Zur Dualität von GKV und PKV / The Future of Private and Public Health Insurance in Germany

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Klaus Dirk Henke
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Managed Care ◽  
Social Health Insurance ◽  
Legal Framework ◽  
Health Insurance System ◽  
Insurance System ◽  
Dutch Health ◽  
The Future ◽  
Private And Public

SummaryThe center of the article deals with the future of the public and private health insurance system in Germany. It analyses therefore both the statutory fund system and the private health insurers. Particular emphasis is put on the Social Health Insurance Competition Strengthening Act 2007 according to which Private Health Insurances will be more affordable for lower income individuals by requiring private insurers to offer a basic benefit package at lower premiums. The idea of managed care has gained momentum in German discussions on health care reform over the past years. Managed care and stronger patient guidance are believed to improve quality of care and to control costs by increasing coordination and the efficient use of health care ressources. In this new environment the question of a possible privatization of the Statutory Fund System arises, a development the Dutch health care system just accomplished. The core idea is to build up non-profit-organisations with integrated care models on the basis of private law. The cons and pros of a new legal framework for the German health insurance system are carefully discussed. Whereas new forms of care may result in less choice for patients, they enable payers to contract selectively and to become players responsible for quality and efficiency of services.

Holes in the Health Insurance System-Who Lacks Coverage and Why

2004 ◽  
Vol 32 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Catherine Hoffman ◽  
Diane Rowland ◽  
Alicia L. Carbaugh
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance System ◽  
Major Health ◽  
Insurance System ◽  
Current Health ◽  
Private And Public ◽  
Care Costs

Lack of health insurance coverage is a large and growing problem for millions of American families. Rising health care costs and economic insecurity continue to threaten the bedrock of the health insurance system - employer-sponsored coverage - while states’ fiscal situations and the escalating federal deficit complicate any efforts at reform. Providing health insurance coverage to the millions of uninsured remains a major health care challenge for the nation and understanding the current health insurance environment, who the uninsured are, and why they are uninsured is critical when considering health care reform. This paper aims to define the problem of the uninsured, providing an overview of the uninsured in America and the roles and limits of private and public insurance. Following this discussion, the paper describes the current health insurance environment and examines the prospects for improving coverage.

scholarly journals Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system

2009 ◽  
Vol 4 (4) ◽  
pp. 405-424 ◽  
Author(s):  
J. HOLLAND ◽  
N.J.A. VAN EXEL ◽  
F.T. SCHUT ◽  
W.B.F. BROUWER
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care System ◽  
Social Health Insurance ◽  
Convenience Sample ◽  
High Loss ◽  
Dutch Health ◽  
Dutch Health Care ◽  
Gp Visits ◽  
Care System

AbstractTo contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system to reward prudent utilization of health services. Internationally, the introduction of a mandatory no-claim rebate in a social health insurance scheme is unprecedented. Consumers were entitled to an annual rebate of ₠ 255 if no claims were made. During the year, all health care expenses except for GP visits and maternity care were deducted from the rebate until the rebate became zero. In this article, we discuss the rationale of the no-claim rebate and the available evidence of its effect. Using a questionnaire in a convenience sample, we examined people’s knowledge, attitudes, and sensitivity to the incentive scheme. We find that only 4% of respondents stated that they would reduce consumption because of the no-claim rebate. Respondents also indicated that they were willing to accept a high loss of rebate in order to use a medical treatment. However, during the last month of the year many respondents seemed willing to postpone consumption until the next year in order to keep the rebate of the current year intact. A small majority of respondents considered the no-claim rebate to be unfair. Finally, we briefly discuss why in 2008 the no-claim rebate was replaced by a mandatory deductible.

scholarly journals Burden of disease due to hip, knee, and unspecified osteoarthritis in the Peruvian social health insurance system (EsSalud), 2016

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 238
Author(s):  
Roger V. Araujo-Castillo ◽  
Carlos Culquichicón ◽  
Risof Solis Condor
Keyword(s):  
Health Insurance ◽  
Burden Of Disease ◽  
Hip Osteoarthritis ◽  
Social Health Insurance ◽  
Social Health ◽  
World Health ◽  
Health Insurance System ◽  
Insurance System ◽  
Life Years ◽  
Social Health Insurance System

Introduction: Since its introduction by the World Health Organization (WHO), the concept of burden of disease has been evolving. The current method uses life expectancy projected to 2050 and does not consider age-weighting and time-discounting. Our aim is to estimate the burden of disease due to hip, knee, and unspecified osteoarthritis using this new method in the Peruvian Social Health Insurance System (EsSalud) during 2016. Methods: We followed the original 1994 WHO study and the current 2015 Global Burden of Disease (GBD) methods to estimate disability adjusted life years (DALY) due to osteoarthritis, categorized by sex, age, osteoarthritis type, and geographical area. We used disability weights employed by the Peruvian Ministry of Health, and the last update issued by WHO. Results: Overall, EsSalud reported 17.9 new cases of osteoarthritis per 1000 patients per year. Annual incidence was 23.7/1000 among women, and 72.6/1000 in people above 60 years old. Incidence was 5.6/1000 for knee osteoarthritis and 1.1/1000 for hip. According to the 1994 WHO method, there were 399,884 DALYs or 36.6 DALYs/1000 patients per year due to osteoarthritis. 12.4 and 2.2 DALYs/1000 patients per-year were estimated for knee and hip osteoarthritis, respectively. Using the 2015 GBD method, there were 1,037,865 DALYs or 94.9 DALYs/1000 patients per year. 31.4 and 5.3 DALYs/1000 patients per year were calculated for knee and hip osteoarthritis, respectively. Conclusions: In the Peruvian social health insurance subsystem, hip, knee, and unspecified osteoarthritis produced a high burden of disease, especially among women and patients over 60. The 2015 GBD methodology yields values almost three times higher than the original recommendations.

Sign in / Sign up

Export Citation Format

Share Document