4 - 2003

Reforming the welfare state

Lots of new rules for health care patients

Above all, those with state health insurance will have to get used to paying more themselves

by Barbara Thurner-Fromm

Health care reform was adopted by the federal government on 26 September 2003. It does not need to be approved by the Bundesrat (upper house). In future, the insured will have to pay for some things themselves, wholly or in part. For many persons this will mean a reduction in their disposable income.

New general rules on deductible costs to be paid by patients

In future, 10% will be deducted from benefits for all medical services; this portion of the costs must be paid by the patient, from a minimum of five euros to a maximum of ten euros. If the cost of any item, such as a medication, is under the minimum deductible of five euros, the patient pays the entire cost out of his or her own pocket. The deductible generally does not apply to children and youth under age 18.

To place a limitation on this new burden, no one is required to pay more than two per cent of his or her gross annual income to cover deductible health care costs; for the chronically ill, the limit is not more than one per cent of gross in come. Families are given consideration through the exemption of children. In the case of those on social welfare, calculation of income will be based on the monthly benefits paid to the head of the household. There will be financial bonuses for those who take active precautions and preventive measures, who enroll in the programme for the chronically ill, or who participate in a family doctor scheme.

Details on deductible payments

In future, ten euros per quarter year must be paid for visits to a doctor or dentist. If the primary care physician refers the patient to a specialist, this fee does not need to be paid again within the same quarter. That means, no matter how many doctors’ visits or referrals one has, this fee is to be paid only once per quarter year. For medications and dressings the deductible is 10%, that is, at least five euros but not more than ten. For equipment such as a wheelchair or hearing aid the deductible is also 10%, but not more than ten euros. There is an exception for supplies which are consumed, such as diapers for an incontinent patient; here the deductible is 10% on each package, but not to exceed ten euros per month.

For a hospital stay, ten euros per day must be paid as deductible, but only up to 28 days in one year. The same deductible applies to in-patient preventive or rehabilitative care: ten euros per day up to 28 days, or 280 Euros a year.

Dentures … will no longer be covered after 2005. From then on, however, the purchase of insurance covering dentures will be required, with the option to choose public or private insurance. Until then, instead of the percentage payments currently in force, there will be "set rates based on need”. Someone who chooses an expensive procedure will not receive any more than one who accepts a less costly one.

Sick pay … which up to now has been half financed by employee and employer contributions, must be covered entirely by the insured from 2006 on. A special contribution of 0.5% will be required to pay for it. Birth and funeral expenses will no longer be paid.

Sterilisation … when it is a personal choice, will no longer be covered; it will continue to be covered only when medically necessary.

Fertility treatments … will only be covered up to 50%, and only for three attempts at conception, rather than for four as at present. This benefit will be available to women between the ages of 25 and 40 and for men up to age 50.

Eyeglasses and seeing aids … will in principle be considered a private expense from now on, with exceptions for children and youth under 18 and for severely visually disabled persons.

Travel expenses … for outpatient treatment also will no longer be covered by government health insurance. There may be isolated exceptions for urgent medical reasons.

Non-prescriptionmedicines … will in principle no longer be covered. There will be exceptions for children under 12, youths with developmental problems, and in treatment of more serious diseases, if the medicines in question are part of standard therapies. Medications purchased to improve one’s private life will not be covered, i.e., no more Viagra at taxpayers’ expense.

Maternity leave, sick pay when one’s child is ill, contraception and abortion will continue to be covered by government health insurance. However, they will no longer be financed from insurance premiums, but rather by taxes, on the basis that these services are in the interests of the society as a whole. To pay for them, tobacco taxes will be raised in three steps, up to one euro per package by 2005.

This article appeared in the daily newspaper Stuttgarter Zeitung on 27 September 2003. The author is editor of the daily newspaper.