How can I get better health care

Better healthcare through more competition

Even if international comparisons should be treated with caution because of the different structural conditions, they may nevertheless serve as an indicator of insufficient effectiveness in the health care system. If you then add the observation that the German health system is lagging behind in terms of digitization compared to other European countries, then it becomes clear that Jens Spahn, the new health minister, has a brilliant task ahead of him. It is surprising why the quality of health care in Germany - which provides top performance in health technology and research and whose doctors are in international demand - is sick. Such a problem can never be explained monocausally, but a major factor is the insufficiently functioning competition between health insurers in this country. Since insurance companies are playing an increasingly important role in the design of care, this lack of competition has an impact on quality.

The limited competition becomes evident when looking at private health insurances (PKV). The fact that a person insured with private health insurance saves premiums at a young age and can only take some of them with him later when changing insurance, making a change of insurance in old age is as good as impossible. This means that there is no significant incentive for private health insurances to stand up for the insured, as they cannot simply switch providers if they are not satisfied. There are concrete proposals to remedy this deficit, such as the option of taking risk-based provisions with you. New providers in the insurance market could then also lure away older insured persons with better service.

In the statutory health insurance system, it seems that competition is not a problem. At least insured persons can change health insurer every year. However, this competition manifests itself primarily in a prize competition and not in the competition for the best offer. The reason for this is, among other things, that the statutory health insurers (GKV) do not see any monetary benefit if they offer their insured persons a better service. Assuming a new app-based service allows policyholders to have better control over their health data and has a certain likelihood of postponing a heart attack - that would actually be a great thing. From the perspective of the GKV, however, costs would be incurred at the time the app was introduced, with hardly any financial advantages in the future. Because once the person has suffered the heart attack, the allocations that health insurance receives from the health fund increase.

The problem of GKV is difficult to get under control, since a financing system with income-dependent contributions makes a risk structure compensation between the health insurances mandatory. But it would help if the decision-makers were more aware of this problem and if the instruments for counteracting it were also tried out. It would be conceivable, for example, to link the allocations to health insurers to their successes in improving the health of their insured persons, as the Monopolies Commission recommends. In addition, the health insurers should be given more opportunities to try out new supply offers in competition.

With more than ten percent of the gross domestic product, the health market is one of the most relevant markets in Germany. It is all the more important to leverage the untapped potential in this market. Mr. Spahn - will you take over?

This post first appeared in the world on April 17, 2018.