PKV study reveals serious weaknesses in performance

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Benefits in private health insurance are often lower than in statutory health insurance

According to a recent study, the benefits in private health insurance (PKV) are often worse than in statutory health insurance (GKV). While the authors of the study speak of partial market failure, the PKV association director Volker Leienbach emphasized to the radio station "MDR INFO" that all tariffs of the private health insurers meet the minimum insurance protection.

In the joint study by the Kiel Institute for Microdata Analysis (IfMDA) and the Frankfurt consultancy PremiumCircle Deutschland GmbH, serious shortcomings in insurance protection are evident in numerous private health insurance tariffs. It is not uncommon for the contracts to include existential exclusions in the event of illness, according to the results of the current investigation. This means that one of the advantages of private health insurance that has always been mentioned up to now loses its validity. The benefits in the private health insurance are by no means more comprehensive than in the statutory health insurance.

80 percent of the PKV tariff systems with less insurance protection than the GKV. As part of the current investigation, the experts from the Kiel Institute for Microdata Analysis and the Frankfurt consultancy PremiumCircle checked 208 tariff systems from 32 private health insurance companies. The study authors report that there are 250,000 different prices for the 1,567 combinations relating to the benefits covered and the various age and gender combinations. According to the study, there were significant gaps in insurance coverage in many private tariffs and insured persons were less entitled to benefits than in statutory health insurance. In the event of illness, existential benefits are often not taken over. "Since the sales market is more commission-oriented and less customer-oriented, the result is that private health insurance tariff tariffs and other private health insurance tariffs are sometimes sold with existential exclusions in the event of illness," said the joint press release from PremiumCircle Deutschland GmbH and the IfMDA. Citing the testimony of the PremiumCircle managing director Claus-Dieter Gorr, “Der Spiegel” had previously reported that more than 80 percent of the PKV tariff systems provide less than statutory health insurance. The study authors cited the lack of entitlement to follow-up treatment or psychotherapy as examples of the poor position of the private insured.

Excess commission and market failure at the PKV According to the study, "a fundamental reorganization of the sales market and also the commissions" at the PKV is "unavoidable" if the "current undesirable developments are to be stopped". According to the experts, "the commissions for the brokers when new contracts are concluded should be reduced to four monthly contributions", the "service fees strictly regulated" and monitored and "inventory management commissions of up to six percent implemented". "The design of the service catalogs and the sales market have become independent over the past 20 years due to the lack of political guidelines," criticized Claus-Dieter Gorr. According to the PremiumCircle boss, the lack of state requirements has led to market failures in some areas of private health insurance. "For the correction, transparent mandatory information on the insured benefits catalog and minimum criteria as a guideline for insurance conditions must be implemented and excess commissions must be ended," continues Claus-Dieter Gorr.

The SHI also reveals weaknesses But not only the PKV reveals significant weaknesses in the current study, the SHI cannot convince comprehensively either. Although the statutory health insurers are in relatively good shape with an expected surplus of 6.46 billion euros at the end of 2012, the "generational conflict between pensioners and employed persons has worsened significantly since the mid-1960s," the study authors report on one of the problems with the SHI. The "SHI in its existing structure is a system without a sustainability perspective and without self-healing powers, since above all health bureaucracy mechanisms have been expanded", the IfMDA and the consulting firm "PremiumCircle" complain. Ultimately there is state failure in the SHI, competition only takes place on paper. The head of the IfMDA, Dr. Thomas Drabinski, emphasized that the legislation "had for decades suppressed the pensioners' problem in statutory health insurance" and that the ever increasing burdens were imposed on the employed under the guise of the generation contract. A fundamental reform of the statutory health insurance system is essential here, "so that the GKV solidarity principle does not become a structure-destroying element," concludes Dr. Thomas Drabinski. (fp)

Read on:
PKV tariffs have massive performance gaps
AOK study: premium increases of 2700 euros
Criticism of the PKV is growing
Discontinued model private health insurance (PKV)
PKV cost trap: How affected people can defend themselves
PKV: For nonpayers only emergency care
Health insurance companies: Non-payers cause losses

Image: Gerd Altmann / Gerold Meiners /

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