Health insurance: Does the SPD want to make well-earning citizens pay?

A new initiative: The contribution assessment ceiling is to be raised by €2,500 to stabilize health insurance companies. But what about expenses?

A nurse pushes a bed down a hospital corridor. Marijan Murat/dpa

Statutory health insurance is becoming increasingly expensive. Supplementary contributions are rising at ever shorter intervals. Now the SPD is proposing to involve high-earning insured persons more closely than before in financing the system.

The Social Democrats are discussing raising the contribution assessment ceiling by around €2,500. Christos Pantazis, health policy spokesperson for the Bundestag parliamentary group, told the "Bild" newspaper this. He suggested that adjusting the contribution assessment ceiling to roughly the level of the pension insurance system could "contribute to easing the financial burden on health insurance companies without placing an undue burden on the insured."

The contribution assessment ceiling for health insurance is €5,512.50, and for pension insurance, €8,050. "For the sustainable stabilization of statutory health insurance finances, we must not impose any restrictions on our thinking," said Pantazis. "We must openly discuss all relevant adjustments. This includes a dynamic adjustment of the federal subsidy as well as a critical review of non-insurance benefits."

The CDU/CSU is opposed to this. "This will unnecessarily increase the cost of work and services, and it will harm Germany as a business location," said Albert Stegemann, deputy parliamentary group leader responsible for health policy.

The statutory contribution is frozen at 14.6 percent, but each of the 94 health insurance funds levies additional contributions based on its financial situation. Significant financial reserves are lacking. The trend in additional contributions has remained the same for years: the curve is pointing upwards. At the turn of the year, they were between 1.7 and 2.9 percent. Thus, revenues are rising, inevitably, because expenses are rising as well. The victims of this overall development are approximately 74 million insured individuals.

Revenues are rising, but so are expenses. The largest item is expenditures for Germany's hospitals . A hospital reform is intended to ease the pressure in this area, but the restructuring of the hospital landscape will initially require €50 billion over the next ten years, regardless of whether it ultimately leads to savings.

Medications are the second-largest cost driver. Last year, spending on medications reached a new high of approximately €55.2 billion. This represented an increase of 9.9 percent over the previous year. Statutory health insurance (SHI) accounted for the largest share of this, namely €53.7 billion. Germany spends more money per capita on pharmaceuticals than any other country in Europe.

Health insurance pays for non-insurance benefits

Added to this are structural deficits, most notably the fact that Germany has so many statutory health insurance funds, with no significant competition among them, but each with its own administrative apparatus. Because they are public corporations, the state is free to draw on their reserves, which Federal Health Ministers Jens Spahn (CDU) and Karl Lauterbach (SPD) have recently done extensively.

Non-insurance benefits such as citizen's allowance or maternity allowance play a role. A portion of the contributions of statutory insured members also ends up in investors' accounts. It arrives there via financial investors, who are increasingly involved in healthcare, not just in hospitals or doctor's offices. Most health insurance funds, for example, utilize the services of a data center backed by a private equity firm.