Die Kopfpauschalen- und Risikoausgleichsdiskussion in der Schweiz
Abstract
Das deutsche und das schweizerische Gesundheitswesen unterscheiden sich trotz ihrer gemeinsamen sozialversicherungsrechtlichen Ausprägung fundamental voneinander. Versorgungspolitisch könnte Deutschland insbesondere von den positiven Erfahrungen der Schweiz im Bereich der Bürgerversicherung, die Schweiz von Deutschland vor allem von jenen im Bereich des morbiditätsorientierten Risikostrukturausgleichs und der teilweisen Beteiligung der gesetzlichen Krankenversicherer an der Lohnfortzahlung lernen.
The discussion about premium models and morbidity based risk structure compensation in the Swiss Health Care System.
The main problem in today’s Swiss health care system are the erroneous financial incentives. In today’s system, the social insurance companies find it more interesting, as a rule, to hunt for good risks. If, for instance, a health insurance fund would have a good care programm for asthmatics, diabetics, or patients with depressions, it would run the risk of becoming interesting for people with those illnesses – and possibily even be recommended by offices representing patients or self-help groups. But if those people choose to join that particular health insurance fund, then its risk structure will worsen and the company will have to increase its premiums. The fundamental problem is today’s risk structure compensation among health insurance funds, which is geared toward age and sex and barely takes the insured’s health condition into consideration. Here, Switzerland can learn a lot of the positive experiences of the morbidity based risk compensation system in Germany. On the other hand, Germany could learn from the positive effects of the introduction of a social health insurance system in Switzerland, where even people with high income or fortune and officials have to pay a premium into the social health insurance system without having the posibility to opt completely out of the system by buying a private insurance solution.
Keywords
Bürgerversicherung, Kopfpauschale, Krankenversicherung, Morbiditätsorientierung, Risikoausgleich, Risikostrukturausgleich, Health premium plan, risk adjustment, risk structure adjustment, social insurance, Swiss Health Care System
