Where is the German health insurance going?


In the last few months, we at adesso insurance solutions have been intensively dealing with the question of where the German health insurance market is heading. We are following the public debate and are in contact with many people in the industry who are also asking this question.       

There are numerous influences currently affecting the dual health insurance system with its coexisting of statutory (GKV) and private health insurance (PKV) systems. The satisfaction of the Germans with the health care system is at a record high (page 16) as sown by a study from the Continentalen Versicherungsbund, a German insurance company.

Political ideas and areas of digital development are influencing the health insurance market in Germany. In the following, I would like to address the political mix, the price of our health insurance, and the advances in digitalization.

The social and political constellation

Currently, the political component around the dual health insurance system is picking up steam because it is an election year in Germany. A look at the first published election platforms of the parties shows some familiar or modified ideas. These consist of the demand for a citizens' insurance, individual steps towards citizens' insurance or adherence to the existing systems. It will be up to the voters to decide. Irrespective of this, the strained financial situation in the GKV system will require a solution. The Federal Audit Office has summarized the financial situation of the statutory health insurance, particularly during the pandemic, and initial reports from the media are forecasting possible premium increases for statutory health insurance by 40 percent. The solutions adopted by the parties are therefore very likely to have an impact on the future dual health insurance system. Whatever the decisions on this may be, it will cost something in the end. Because the old economic saying holds true: "There is no such thing as a free lunch!"

The price of our health insurance

The general belief that private health insurance is becoming more and more expensive for those with comprehensive insurance and is overtaking statutory health insurance in the process has already been disproved in a ten-year comparison. It is actually currently the other way round. We will not go into the comparison of services here. But there is a reason that the share of private supplementary insurances is rising. This is due to the benefits and the fact that the statutory health insurance catalog of benefits is constantly being adapted. So for each of the systems individually and across systems, policyholders are asking for health solutions.

The financing of the two systems is different and while the private health insurance has expanded its demographic reserves in recent years, the statutory health insurance is currently having to reduce its reserves. The decrease in statutory health insurance reserves is large, so that the first voices from the statutory health insurance sector are already warning of the consequences. This could be followed by increases in health insurance premiums, cuts in benefits or further tax subsidies. However, gradual reforms of the rules of the dual health insurance system would also be possible.  

Digitalization in the dual health insurance system

In the dual health insurance system, the central player with a statutory mandate is gematik GmbH, which is responsible for the introduction and further development of the electronic health card (eGK)and the telematics infrastructure (TI) - the digital health network for Germany. Since 2015, the eGK has been the proof of entitlement to claim benefits from the statutory health insurance.

The E-Health Act regulates the implementation plan for the development of the TI and the introduction of medical applications. The eGK is the insured person's central key to these applications.

The GKV is already gradually implementing this digitalization and is working on introducing the electronic prescription, the electronic patient file and other features. And they go even one step further. Since 2016, the GKV central association has been investing in an innovation fund and supporting new forms of care and research. The fund has an annual volume of EUR 200 million. As a result of the Digital Care Act, the health insurance funds have also had the opportunity to additionally invest in the development of digital solutions since 2019.

By acquiring a stake in gematik GmbH, the private health insurance system has also decided to support the infrastructure and play an active role in the development and operation of the TI. In addition, the private health insurance association set up a digital healthcare fund with its members. The resulting heal.capital Management GmbH recently reached the 100 million euro mark to invest in promising digital ideas. This is an impressive investment budget, given that the proportion of people with comprehensive private health insurance accounts for just under 11% of the total number of people with comprehensive health insurance in Germany.

Health insurance system in transition?

Health concerns us all and forms a basis for our quality of life. That is why it is important that our dual health insurance system continues to work well for insured individuals in the long term. However, the situation has rarely been so exciting. In addition to the digitalization already described, we are also in the midst of demographic change and the consequences of the current pandemic cannot yet be properly assessed. The federal election this year will also set the trend. It's very exciting.

Partner for private health insurance companies

adesso insurance solutions GmbH has been developing solutions for partner, portfolio and benefit systems in the private health insurance sector for many years. adesso constantly queries the needs of our customers as part of partnership forums and projects and, together with our internal industry experts, translates these needs into standardized software. In addition, together with Versicherungsforen Leipzig, we have been observing the insurance and healthcare market for many years. The current result is available in the form of the study "The role of private health insurance in the healthcare system of the future". Make sure you get a free copy. It is our contribution to outline the future of private health insurance with guard rails, together with private health insurance decision-makers and experts and with the involvement of insured persons. These guardrails can help us on our shared journey to develop the dual health insurance system and achieve the best outcomes for our customers and the insured. 

If you are a private health insurance company and would like to know how our software can support you in this process, please contact our expert, Holger von Mallek.

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