The financial situation of statutory health insurance continues to deteriorate

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Written By Rivera Claudia

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Berlin – The financial situation of the statutory health insurance (GKV) in Germany continues to deteriorate. This is demonstrated by the so-called KV 45 figures, i.e. the financial development of the GKV, for the first half of this year. The figures provided by the Federal Ministry of Health (BMG) presented show: Everything is getting more expensive.

Thus, the 95 health insurers recorded a deficit of 2.2 billion euros in the first six months of the current year – in the first three months of the current year a deficit of 776 million euros was recorded.

Financial reserves amounted to around €6.2 billion at the end of the first half of the year. This corresponds to 0.23 monthly expenditures and therefore only slightly more than the legally required minimum reserve of 0.2 monthly expenditures.

Health insurers’ revenues of €159.1 billion were offset by expenses of €161.3 billion. The health fund had to give up: it posted a deficit of €6.3 billion in the first half of the year. The ministry described part of the deficit as “seasonal”.

However, EUR 3.1 billion was distributed to health insurers from the liquidity reserve in order to stabilise the additional contribution rates of health insurers. However, this was only partially successful. At the beginning of the year, the average additional contribution rate charged by health insurers was 1.70 percent. By August 2024, 22 health insurers had increased their additional contribution rates during the year.

The average additional contribution rate charged by health insurers in August was 1.78 percent, 0.08 above the average additional contribution rate announced at the end of October 2023 for 2024.

“This means that there are no more reserves available to prevent or even mitigate premium increases in the coming year – and the Federal Health Minister is standing by and doing nothing,” said the CEO of the National Association of Statutory Health Insurance Funds, Doris Pfeiffer, commenting on the figures.

For 2025, the National Association of Statutory Health Insurance Funds now expects an additional contribution rate of at least 2.3 percent, i.e. 0.6 percentage points more than this year. And that does not even take into account upcoming legislative proposals, such as the costly hospital reform, according to the health insurer. This could increase the GKV contribution by a further 0.1 percent.

“Politicians seem to have gotten used to increasing additional contribution rates – but we haven’t,” says Pfeiffer. Annual increases in contribution rates to finance medical and nursing care should not be an obvious health policy instrument. “As a result, the financial resilience of policyholders and employers is increasingly strained.”

On August 7, the Federal Office of Social Security (BAS) called on politicians to ensure that “the adjustment screws are tightened to ensure sustainable security of the systems”. BAS President Frank Plate had this to say in the current Activity report emphasized by authority.

He had pointed this outthat at the beginning of the year some health insurers were charging a higher additional contribution. In the meantime, financial development continues to gain significant momentum and is even developing “even less favourably than previously assumed”. Securing the finances of the GKV in the long term remains an “urgent political objective”.

The situation at the cash registers differs

As is the case every year, the situation with the individual health insurance companies varies. The replacement funds ran a deficit of EUR 859 million, the local health insurance funds EUR 721 million, the company health insurance funds EUR 366 million, the guild health insurance funds EUR 161 million and the Knappschaft EUR 43 million. The agricultural health insurance company, which does not participate in the risk structure compensation, posted a deficit of EUR 8 million.

The GKV figures also make it clear that expenditure has grown significantly. According to the ministry, health insurers recorded a “very dynamic increase in expenditure on services and administrative costs of 7.3 percent” in the first half of 2024.

In detail, performance expenses increased by 7.6 percent, significantly more than in previous years. Administrative costs decreased by 1.2 percent. In absolute terms, health insurers’ service expenses increased by 10.9 billion euros in the first half of the year.

Administrative costs fell by €75 million, with €280 million less in pension provisions than in the same quarter of the previous year. Administrative costs excluding pension provisions rose by 3.5 percent in the first half of the year.

Expenditure on hospital treatment increased significantly – by 7.9 percent (+3.6 billion euros). This represents a “significant driver of the high dynamics of expenditure”, as the ministry writes. In addition to a very dynamic price component and the increase in the number of cases, costs for nursing staff in particular increased again “extremely dynamically” in the first half of the year, by around 10.9 percent (+1.05 billion euros).

The costs of the special remuneration at sectoral level or hybrid DRG introduced in December 2023 are limited. In the first half of the year, around 181 million euros were recorded.

Excessive spending on medicines

There were also significant additional costs in the supply of medicines: expenditure rose by 10.0 percent (+2.5 billion euros) in the first half of the year, slightly more than in the first quarter. “When interpreting this extremely dynamic development, it should be noted that it is particularly influenced by the expiration of the statutory manufacturer discount from seven to twelve percent, which was increased once in 2023 by the Financial Stabilization Act GKV,” writes BMG.

In the first half of 2024, the discounts granted by pharmaceutical companies in favour of the GKV decreased by around 547 million euros. “However, even without taking these discounts into account, expenditure grew strongly by 7.3 percent (+1.94 billion euros). Expenditure on pharmaceutical products in the context of specialist outpatient medical care also showed extremely dynamic growth, showing an increase of around 347 million euros (equivalent to +49.6 percent) compared to the value in the same half of the previous year.

More expensive outpatient services

Expenditure on outpatient medical treatment increased by 5.3 percent (+EUR 1.3 billion) in the first half of the year. Expenditure on extra-budgetary psychotherapeutic services showed above-average growth (+6.8 percent or +EUR 116 million).

According to the ministry, expenditure on outpatient operations according to the AOP catalogue also grew more dynamically than the overall area, with growth of around 9.2 percent (+106 million euros). Health insurers have earmarked around 35 million euros for the billing of the so-called hybrid DRG by resident doctors.

Spending increased sharply in the area of ​​home care and nursing (+12.4 percent or +€569 million) as well as in preventive and rehabilitation services (+11.1 percent or +€231 million). The latter has shown above-average dynamics since 2022, following the pandemic-related declines of recent years.

When interpreting the data from the first half of the year, it must always be taken into account that expenditure in many service areas, especially for doctors, is still based on estimates, since billing data is not yet available or is only partially available, according to BMG.

The GKV estimators must now forecast the development of policyholders, expenses and GKV revenues for the current and next year by mid-October. BMG then wants to announce the new average additional contribution rate to cover the expenses for 2025 by November 1. The financial results for the 1st to 3rd quarter of 2024 are expected to be available at the end of November. © may/EB/aerzteblatt.de

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