In the healthcare sector, there is currently almost only one topic, dealing with the corona pandemic, the situation in the hospitals, the appreciation of the nursing staff.

The uncertain financing of the future supply recedes into the background.

There are huge gaps in the health and long-term care insurance funds that can only be filled with great effort: with increased contributions, recourse to reserves, but above all from tax revenue.

The already high federal subsidy for statutory health insurance (GKV) will double in 2022 to 28.5 billion euros.

Christian Geinitz

Business correspondent in Berlin

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But the bad news doesn't stop.

Only the top dog on the market, the Allgemeine Ortskrankenkassen (AOK), reported an unprecedented deficit for the past year.

It is even higher than the record underfunding of all funds combined at the beginning of the 2000s.

In 2002 and 2003, expenditure for all insurance companies together exceeded income by around EUR 3.4 billion.

Fifteen years followed, in which there were mainly surpluses, until 2019 when the bill turned negative again.

In 2020 it looked particularly bad at minus 2.7 billion euros.

But that is nothing compared to the horror numbers of the AOK for 2021, which the FAZ has available.

According to this preliminary data, the financing gap last year was a whopping 4.1 billion euros.

That was EUR 1.5 billion more than the AOK reported in the first three quarters.

And it meant a quadrupling of the AOK deficit from 2020. For comparison: in 2019 the financial deficit of the association was only 121 million euros, in 2018 and 2017 there were even whopping surpluses of more than one billion euros.

Other registers also in the red

The other associations, such as those of the replacement, company and guild health insurance companies, have not yet published their figures.

However, they too were in the red up to the third quarter, with the exception of the small agricultural funds and the large substitute funds.

At that time, the entire system had reported minus 3.2 billion euros.

Even if the substitute health insurance association should have expanded its small surplus of 70 million euros in the fourth quarter, no fundamental improvements in the GKV finances are to be expected in view of the overwhelmingly bad AOK data.

2021 could therefore go down in statutory health insurance history as one of the worst or perhaps even the worst year ever.

In addition to the AOK, the small miners' association also presented their annual figures.

She incurred a deficit of 104 million euros, slightly less than 2020 with 138 million at the time.

Knappschaft managing director Bettina am Orde makes it clear that the burdens were not due to the corona pandemic.

On the contrary, there was a “pandemic-related reluctance on the part of the insured to claim insurance benefits,” said Orde on Friday.

Rather, the shortfall has to do with the capital levy, i.e. the recourse to the reserves.

The previous federal government with Health Minister Jens Spahn (CDU) had imposed this on the health insurance funds in order to stabilize the GKV finances.

The reason for this was that the cash reserves were several times the statutory minimum reserve, which Spahn understandably wanted to melt down before he took other financing paths, such as contribution increases.

AOK "disproportionately" charged

Orde complained that such funds would have had to dig deep into their pockets "that had been economical with insured persons' money in the past".

The Knappschaft had to pay 187 million euros to the health fund.

Across all coffers, the wealth levy was 8 billion euros.

Orde demanded: "The health insurance companies immediately need a reliable financial basis and planning security for the coming years."

The local health insurance companies also feel that they have been badly hit, and they also cite special effects as an explanation for the poor performance.

The AOK community was "disproportionately" burdened by the release of the financial reserves, namely with 4.2 billion euros, said the new chairwoman of the AOK federal association, Carola Reimann.

Furthermore, the reorganization of the so-called risk structure compensation (RSA) had a particularly negative effect on the AOK family.

The RSA is a kind of financial equalization among the funds, which is intended to ensure that insurance companies with an above-average number of sick people do not suffer any competitive disadvantages.

According to the AOK, however, the reform must be revised because it offers “considerable risk selection incentives”.

These were “particularly at the expense of people in need of social protection and vulnerable people”.

As far as the future cash position is concerned, Reimann warned: “Now our reserves have been largely used up.” At the same time, after the Corona wave “strong catch-up effects and an increase in expenditure can be expected in the near future”.

According to the head of the association, the new federal government must react to this: “In view of our weakened financial basis and a worsened competitive position, we expect politicians to send clear signals for financial stabilization.”