Compulsory savings in the healthcare system: Do you now have to pay for the dentist yourself?

1. Better and cheaper treatment, but longer distances

That happened: Federal Health Minister Karl Lauterbach (SPD) has initiated a hospital reform. The facilities should have clear service areas and be transparently evaluated according to quality. Bad hospitals don’t get any money anymore. This goes to better institutions.

That’s behind it: Germany is currently paying a lot for hospitals, but offers a rather poor quality of care in international comparison, argues Lauterbach. The reform aims to encourage competition between hospitals, weed out poor facilities and thus reduce costs and improve treatments.

The data confirm Lauterbach’s assessment: the statutory health insurance companies (GKV) have been paying more and more for hospital stays for many years.

What it means for insured persons: The reform should actually increase the quality of treatment and reduce costs or at least prevent further increases. Disadvantage for patients: If the bad hip surgery in the hospital around the corner is eliminated, they may have to drive further to the next good facility. Safer and cheaper, but less convenient.

How likely is the change? Secure. The federal and state governments have agreed on the most important points.

2. Fewer unnecessary treatments

That happened: Another point in Lauterbach’s hospital reform is the end of flat rates per case. In the future, hospitals should no longer be paid exclusively per treatment, but to a large extent for providing the services – similar to a fire brigade.

That’s behind it: Patients and doctors have been complaining about the time pressure caused by case flat rates for years. Those who are paid per patient have to treat many patients quickly in order to survive. That harms the quality.

According to critics, the old system also motivated doctors to carry out as many large-scale interventions as possible: an operation generates more income than outpatient treatment. So doctors performed some superfluous surgeries.

What it means for insured persons: The new system aims to avoid unnecessary treatments. In the future, patients could rely on being treated for medical reasons and not for financial reasons, says Lauterbach. Fewer unnecessary treatments also put the brakes on costs and contributions.

How likely is the change? Also safe, because part of the hospital reform mentioned in the previous point.

3. Pay for homeopathy yourself

That happened: Federal Health Minister Karl Lauterbach wants health insurance patients to pay for homeopathic treatments themselves. In a science-based health policy, these services have “no place,” he told the “Spiegel”. Some health insurance companies currently offer reimbursement for homeopathic medicines as an additional service.

That’s behind it: Homeopathic treatments are treatments whose effectiveness has not been scientifically proven. Critics argue that if health insurance companies cover homeopathic services, some policyholders will pay others for useless medicines.

What it means for insured persons: Very few insured use homeopathy offers. The omission affects hardly anyone. However, it probably does not reduce the contributions either: According to the Federal Ministry of Health, statutory health insurance paid around 6.7 million euros for homeopathy in 2020 – less than one hundredth of one percent of all expenditure.

How likely is the change? Probably. In addition to Lauterbach, the FDP has also been criticizing homeopathy payments for a long time. The Greens are more cautious, but the majority of the coalition appears to be behind the abolition. The Ministry of Health is currently examining the abolition.

4. Pay the dentist yourself?

That happened: IKK boss Ralf Hermes demanded in the Handelsblatt to delete “the complete dental care from the catalog of services” of the health insurance companies.

That’s behind it: The statutory health insurance companies paid around 13 billion euros for dental treatment in 2022 – around five percent of the total expenditure. Hermes wants to save these costs in order to relieve the cash register. Proponents of the idea are hoping for a slower increase in contributions.

Critics see it differently: The National Association of Statutory Health Insurance Dentists speaks of a “basically completely anti-social demand formulated against all scientific knowledge”. Preventing periodontitis also slows down diseases such as diabetes mellitus or rheumatoid arthritis. This saves you expensive costs for other treatments.

What it means for insured persons: If politicians implement the proposal, insured persons would have to pay for dental treatment themselves or book additional insurance. It would also be conceivable that some health insurance companies would continue to pay for visits to the dentist as an additional service and charge higher premiums for them.

How likely is the change? Health Minister Lauterbach firmly rejected service cuts on Twitter. Drastic interventions such as an end to the dentist takeover therefore currently appear to be out of the question.

5. Higher deductible?

That happened: Financial scientist Bernd Raffelhüschen calls for a high deductible for patients with statutory health insurance: “In the future, you should pay the first 800 euros for doctor visits (with the exception of inpatient surgeries) yourself”.

That’s behind it: After secured finances this year, the coffers are again threatened with a deficit for 2024. Insured persons must therefore once again adjust to rising contributions. Raffelhüschen’s approach is intended to avoid increases in contributions.

What it means for insured persons: Much of Raffelhüschen’s proposal remains unclear: To what period does the deductible refer? quarter, year, each treatment? In any case, the implementation would probably be more expensive in the short term than an increase in contributions. If the exemption applies per treatment, it would be significantly more expensive.

It is unclear whether the idea will save costs in the long term. Critics fear that people could see the doctor less often, which allows diseases to thrive and later causes expensive follow-up costs that could have been avoided with earlier treatment.

How likely is the change? Unlikely. Raffelhüschen had suggested in February that those with statutory health insurance should pay a deductible of up to 2,000 euros per year. This met with widespread rejection. Even after the participation was reduced to 800 euros, he hardly received any approval.