Berlin. German industry is calling for more competition in the healthcare system in order to limit the rising costs of health insurance companies. But it is precisely this competition that is not making any progress. This is the finding of a study by the German Economic Institute (IW), which is available exclusively to Handelsblatt and was commissioned by the Federation of German Industries (BDI). Accordingly, statutory health insurance companies lack the incentive to organize care more cheaply.
The IW economists Jochen Pimpertz and Jasmina Kirchhoff recommend improving the conditions for the use of new technologies. The consulting firm Prognos had already examined how great the savings potential is in 2025 on behalf of the BDI. According to this, health insurance companies could save almost 21 billion euros annually through medical innovations. The contribution rate would therefore be 1.4 percentage points lower by 2045.
But how could incentives be created for health insurance companies to organize care more cheaply through these innovations?
The study authors recommend greater freedom of contract, which would allow health insurance companies to develop new treatment concepts together with doctors and clinics. In this way, patients can be managed more specifically through the health system and unnecessary examinations can be avoided, the economists emphasize.
The authors also focus on the insured. They propose different tariffs:
Anyone who voluntarily chooses certain doctors could pay less.
On the other hand, if you want to continue to freely choose which doctor you go to, you may have to pay higher contributions.
Oliver Blatt, CEO of the National Association of Statutory Health Insurance Funds, thinks little of it. “The idea of restricting the freedom to choose a doctor with the aim of reducing health insurance contributions would certainly not be productive,” he told the Handelsblatt. Contributions would have to be based solely on income, while medical care would have to be based on individual needs.
Blatt, however, welcomes more freedom for health insurance companies when it comes to contracts with doctors and clinics. “More individual contract options for individual health insurance companies have the potential to drive innovation,” he said.
The IW study's proposals come at a politically explosive time: The federal government is discussing further reforms to financially stabilize statutory health insurance. The “Health Finance Commission” plans to present its second report on December 18th. According to their calculations, without further countermeasures, the health insurance companies' financing gap would grow to around 40 billion euros by 2030.
In addition, in the future, care will be organized more closely via a digital initial assessment and the family doctor, via a so-called primary care system. Federal Health Minister Carsten Linnemann (CDU) wanted to present a first draft bill for this this year.
The GKV contribution stabilization law that has already been passed should help in the short term. It goes back to the Commission's first report and is intended to relieve the burden on the coffers by a good 19 billion euros in the coming year. The contribution rates could initially remain stable, as recent forecasts by the GKV estimators and the Federal Ministry of Health show. However, how much insured people actually pay also depends on the additional contribution of their health insurance company, which the insurance company determines itself.
The industry also has an interest in lower contributions. Rising health insurance contributions make employees more expensive for companies. At the same time, drug and medical technology manufacturers could benefit if their products are used more frequently, as the Prognos study suggests. The BDI member companies would also benefit from this development.
Prognos examined how much money new technologies could save using 21 examples.
Digital applications: Their consistent use could reduce the burden on the coffers by a good 7.2 billion euros annually. Special software would help hospitals find free beds more quickly. Doctors could offer certain consultations and therapies online more often, and electronic registries would make it easier to compare treatment results.
Medical technology: According to Prognos, a further around nine billion euros could be saved annually through medical technology innovations. These include surgical robots, artificial intelligence in diagnoses and implants from 3D printers. However, the greatest potential lies in outpatient care: medical technology could provide outpatient care for up to 2.7 million previously inpatient cases each year. This alone could save around six billion euros.
Pharmaceuticals, biotechnological processes: Prognos sees further potential of 4.6 billion euros in this area. New therapies could, for example, prevent complications from diabetes. Measures against antibiotic resistance and the use of cheaper imitation preparations, so-called biosimilars, could also reduce costs.
However, these numbers are not a forecast in the strict sense. They are based on selected examples and simplifying assumptions. The new IW study also does not quantify any additional savings. How much could be saved through more competition cannot be calculated in advance, says IW economist Pimpertz. Because what new treatment options are emerging is still unknown today. “That would require knowledge that first has to be developed in competition,” he says.
Health economist Martin Albrecht from the Iges Institute also considers the magnitude of the previous savings estimates to be fundamentally plausible. However, he cautions against equating potential savings with actual cost reductions.
Digital patient control could save doctors treatment time. However, if you use these for further sessions or if additional patients are added through digital offerings, your expenses will not necessarily decrease. “The decisive factor is less the type of digital innovation than how it is embedded in real supply processes,” says Albrecht.
He also expects more competition and greater contractual freedom. They could enable a “competition for efficient care management” in which doctors, clinics and other healthcare professionals coordinate their work better with the help of digital systems.
