Consumer advocates are calling for rapid private health insurance reform

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Consumer advocates are calling for reform of private health insurance

More and more privately insured people are complaining to the consumer advice centers about massive increases in tariffs from the private health insurers. Therefore, consumer advocates are calling for a far-reaching reform of the private insurance system. The Association of Private Health Insurance Companies (PKV) declines: the sample is "deeply dubious". The system had no problems.

Numerous complaints about premium increases
More and more insured persons from private health insurance companies are complaining to consumer protection centers about rapidly increasing premiums. The Federal Association of Consumer Centers (vzbv) undertook an evaluation of a total of 144 complaints from insured persons of the private health insurers, which were received by the central offices between December 2011 and March 2012. It showed that the contributions in individual tariffs rose by an average of 23.9 percent. Some of those affected even had to accept a premium increase of 60 percent. According to the experts, customers who were insured with a provider over a long period of time and older policyholders were particularly affected. "Our fears were far exceeded," says Michael Wortberg, insurance expert at the Rhineland-Palatinate Consumer Center. In no way only 144 people complained. The study is just a sample, as consumer advocates emphasized. Far more complaints were received.

Older policyholders particularly affected
The complaints include, with a few exceptions, contracts that exist for more than ten years and insured persons who are older than 45 years. "Customers report that under no circumstances can they pay the amount of the premium once they are retired," says consumer advocate Wortberg. In one case, a 59-year-old woman paid a monthly contribution of 1095 euros. If you then only receive a pension of 1200 euros, you are lost. Because the contributions in the PKV are not based on income, as is the case with statutory health insurance, but on the tariff concluded.

Bills of exchange are often undermined by providers
In the course of the study, it became clear that the right to switch the insured to a cheaper tariff is often undermined by health insurance companies. Only four of the 144 customers were able to switch to another tariff without any problems. "The possibility to switch to cheaper tariffs within the private health insurance has to be easier," said Gerd Billen, board member of the Federal Association of Consumer Centers. In addition, Billen criticized that the PKV lacks "effective cost containment". In his opinion, the introduction of the benefit in kind principle would make sense as part of a reform. The consumer complaints are "perhaps only the tip of the iceberg," said Billen.

Reform of the cost reimbursement model called for
Another requirement is a reorganization of the reimbursement of costs. According to the current model, the private patient has to submit the received invoice from the doctor or the clinic to his private fund. Instead, the billing should take place between the service provider and the insurance company, says Billen.

The top consumer advocate demanded more influence from politics. The Federal Minister of Health Daniel Bahr (FDP) should have the various private health insurance tariffs examined "systematically and quickly". The goal should be consumer-friendly reform. It had to be about "compensating for deficits in justice and achieving efficiency increases" in order to stop the "explosion of contributions" in private health insurance. "The consequences of a financial overload of consumers must not be socialized, but must be resolved within the private health insurance system," warned Billen. "It is not acceptable for physicians to pay more for privately insured people than for other patients," he said. Here, too, politics had to rethink the previous situation.

PKV describes the consumer protection study as dubious
The Federal Association of Private Health Insurance (PKV) described the sample as "untrustworthy". Volker Leienbach, chairman of the association replied that different and independent analysts had calculated an average increase in the contributions of the individual tariffs of only two percent. Every insured person would have the right to switch to a different tariff from the provider. This regulation is enshrined in law. In contrast, statutory health insurance contributions have increased by 3.1 percent since 1997. That of the PKV by 3.3 percent. This results in a similar order of magnitude in the contribution structure. "The rising health costs affect both insurance systems equally," Leyenbach wrote in a statement. According to the association, around 8.9 million people in the private health insurance are fully insured. (sb)

Also read:
DAK without additional contribution: AOK aggressive
Private cash registers are no longer portable
Discontinued model private health insurance (PKV)
Manipulations by PKV representatives

Image: Gerd Altmann / Gerold Meiners /

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