(Mess; 01-06; p.4)
On revenue:
Premiums for the GKV will be stipulated by law,
the insurers have to cover 95 % of their costs by them. The premiums,
which are subdivided in a 50.5 % share of the employees and a
49.5 % share of the employers, will be handled by "Länder"-authorities
for a health-fund. – The law makers did not give a balance of
costs in respect to the necessary restructuring of work places
and jobs with the GKV and the state.
Insurers within the GKV-system will get equal
"Länder"-based adjustments to the premiums for the health-fund.
These risk-based adjustments – for an insured populace above or
below average concerning age, sex or health-condition – will replace
the risk-adjustment between GKV-insurances. – The law makers refrained
from taking the PKV into that system, so a system-independent
risk-adjustment was not created.
Up to five percent of their costs, the GKV-insurers
may finance by extra premiums; an individual upper limit for households
will be at one percent of gross income. Extra premiums may be
collected by the insurers themselves or by the respective "Länder"-authorities;
a possible dividend may be given back by the insurances.
Insurers within the GKV-system who cannot cover
their costs have to go bankrupt or merge with another GKV-insurance.
So, the whole system has to be lead by general accounting rules
laid down in the German law on trade (the "Handelsgesetzbuch")
and insurers are held liable, although, in case of a merger only
temporarily. – Whether the tax payer will have to make good for
claims of doctors, hospitals or the pharmaceutical industry and
whether and how these claims will have to be enforced, the law
makers did not yet resolve.
Children will have to be insured by the GKV
cost-free still, costs will have to be covered by the tax payer.
– The law makers did not provide the GKV with enough resources
for that item so that in effect the deficits will have to be financed
by extra premiums of employees. If cases will be filed by PKV-customers
who have to pay for their insured children against this double
charging, remains to be seen.
(end of article)
