FAZ exclusiv: Expenditure in the health care system is completely out of control

The financing of the German healthcare system is increasingly out of control.

This is due to the fact that the income in the gloomy economy cannot keep pace with the sharply increasing expenditure.

The corona pandemic is not decisive for this, it even slowed down cost growth at times, as fewer patients went to the doctor, dentist, for rehabilitation or preventive care and expensive operations were postponed.

The health insurers complain that the expansion of services has ruined the balance sheets, for example for expensive medicines.

In addition, the previous federal government with Health Minister Jens Spahn (CDU) had forced the insurance companies to reduce their reserves in order to avert increases in contributions.

Christian Geinitz

Business correspondent in Berlin

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According to the provisional figures from the health insurance associations, which are available to the FAZ, the deficit in statutory health insurance last year was almost 5.7 billion euros.

That was more than twice as much as in 2020, when it was 2.7 billion euros.

And it meant the worst ever outcome in healthcare history.

The previous negative record was recently incurred in 2003 with around 3.44 billion euros.

In 1992 – still in the days of the Deutsche Mark – the shortfall had reached the equivalent of more than 4.8 billion euros, but never exceeded 5 billion.

The general local health insurance companies (AOK) reported the highest deficit in 2021 with 4.1 billion euros, four times as much as in 2020. In addition to the burdens mentioned, the member companies of the AOK Federal Association also suffered from the reform of the so-called risk structure compensation (RSA), a kind of Financial equalization among the different types of insurance.

The other large association, that of the substitute funds (Vdek), reports a deficit of 576 million euros for 2021.

That's only half as much as in 2020, but by the third quarter of 2021 the replacement funds had even generated a small surplus.

But it was eaten up, because in the fourth quarter the underfunding was 646 million euros.

The company health insurance companies are also running a deficit

In the period from October to December, the expenditure on pharmaceuticals in particular rose sharply, said the Vdek association of health insurance companies.

Compared to the same quarter of the previous year, growth was 13 percent per insured person.

Some new drugs cause annual therapy costs of more than one million euros, it said.

In dental care, the statutory increase in fixed subsidies and new guidelines on periodontal disease would have inflated expenditure.

In the case of remedies, the remuneration has increased by almost 12 percent per insured person due to legal requirements.

All in all, the expenditure of the substitute funds per insured increased by 7.5 percent.

Unlike the AOK, however, they also benefited from the reorientation of the RSA, so that total income increased by more than 8 percent.

The company health insurance companies report a deficit of 500 million euros for 2021, twice as much as in the previous year.

In the case of the guild funds, the minus was 409 million after 250 in 2020. The small miners' association reduced their shortfall slightly from 138 million to 104 million euros now.

All figures are provisional and do not include all of the more than 100 individual cash registers.

So far, the agricultural funds have not reported any data;

but they are comparatively insignificant.

As an explanation, the Association of Guild Health Insurance Funds announced that a major driver of the deterioration had been the reduction in assets decided by the federal government, i.e. the use of the cash reserves intended to stabilize contributions, which had comprised a multiple of the statutory minimum reserve.

Corona also had a negative impact, it was said: In the third quarter, after the restrictions were lifted, there were catch-up effects, and spending then remained at a high level in the fourth quarter despite renewed restrictions and high incidences.

The large substitute health insurance association Vdek felt the corona pandemic as a roller coaster on the financial side.

"Catch-up effects and loss of performance alternated," said Vdek chairwoman Ulrike Elsner.

The deficits in the system were to be expected as special effects in 2021, in particular because of the property tax totaling 8 billion euros, of which the substitute funds had to shoulder 2.3 billion.

But Elsner assured: "For 2022, the financing of statutory health insurance is - as of today - secured." However, this is also due to the fact that the already high federal subsidy from tax funds has almost doubled to 28.5 billion euros in the current year.

For 2023, Elsner expects another financial gap in the system of 17 billion euros.

In order to close these, the federal government must, among other things, introduce a “cost-covering contribution rate for recipients of unemployment benefit II” and decide on a reduced VAT rate on health services, such as for pharmaceuticals.

"At the same time, efficiency and cost-effectiveness must be at the top of the federal government's agenda again," demanded the head of the association.