Hospital.Help

Berlin – The financial situation of the statutory health insurance (GKV) in Germany continues to deteriorate. This is shown by the so-called KV-45 figures, i.e. the financial development of the GKV, for the first half of this year. The figures presented by the Federal Ministry of Health (BMG) show that everything is getting more expensive.

According to this, the 95 health insurance companies incurred a deficit of 2.2 billion euros in the first six months of the current year – in the first three months of the current year a deficit of 776 million euros was recorded.

Financial reserves amounted to around EUR 6.2 billion at the end of the first half of the year. This corresponds to 0.23 months’ expenditure and is therefore only slightly more than the legally required minimum reserve of 0.2 months’ expenditure.

The health insurance companies’ income of 159.1 billion euros was offset by expenditure of 161.3 billion euros. The health fund suffered a setback: it recorded a deficit of 6.3 billion euros in the first half of the year. The ministry described part of the deficit as “seasonal”.

However, 3.1 billion euros were distributed from the liquidity reserve to the health insurance companies in order to stabilize the additional contribution rates of the health insurance companies. However, this was only partially successful. At the beginning of the year, the average additional contribution rate charged by the health insurance companies was 1.70 percent. By August 2024, 22 health insurance companies had increased their additional contribution rate during the year.

The average additional contribution rate charged by health insurance companies in August was 1.78 percent, 0.08 percent higher than the average additional contribution rate announced at the end of October 2023 for 2024.

“This means that there are no longer any reserves available to prevent or even mitigate increases in contributions next year – and the Federal Minister of Health is watching idly,” said Doris Pfeiffer, Chairwoman of the National Association of Statutory Health Insurance Funds, commenting on the figures.

For 2025, the GKV umbrella association is now expecting an additional contribution rate of at least 2.3 percent, i.e. 0.6 percentage points more than this year. And this does not even take into account upcoming legislative proposals such as the costly hospital reform, according to the health insurance side. This could increase the GKV contribution by an additional 0.1 percent.

“Politicians seem to have gotten used to increasing additional contribution rates – but we have not,” says Pfeiffer. Annual increases in contribution rates to finance medical and nursing care should not be a standard instrument of health policy. “The financial capacity of the insured and employers is increasingly being overstretched as a result.”

On August 7, the Federal Office for Social Security (BAS) had already called on politicians to ensure that “the adjustments are made to ensure the sustainable security of the systems.” BAS President Frank Plate emphasized this in the agency’s current activity report.

He pointed out that at the beginning of the year some health insurance companies had charged a higher additional contribution. In the meantime, financial developments are gaining momentum and are even developing “even more unfavourably than previously assumed”. The long-term safeguarding of the finances of the statutory health insurance system therefore remains a “primary political goal”.

Situation at the cash registers differs

As in every year, the situation at the individual health insurance companies is different. The substitute health insurance companies recorded a deficit of 859 million euros, the local health insurance companies 721 million euros, the company health insurance companies 366 million euros, the guild health insurance companies 161 million euros and the miners’ association 43 million euros. The agricultural health insurance company, which does not participate in the risk structure compensation, recorded a deficit of 8 million euros.

The GKV figures also show that spending has grown considerably. The health insurance companies recorded a “very dynamic increase in service expenditure and administrative costs of 7.3 percent” in the first half of 2024, according to ministry spokespersons.

In detail, expenditure on services rose by 7.6 percent, which is significantly more than in previous years. Administrative costs fell by 1.2 percent. In absolute terms, health insurance providers’ expenditure on services rose by 10.9 billion euros in the first half of the year.

Administrative costs fell by EUR 75 million because around EUR 280 million less pension provisions were booked than in the same quarter last year. The increase in administrative costs excluding pension provisions was 3.5 percent in the first half of the year.

Expenditure on hospital treatments has increased significantly – by 7.9 percent (+3.6 billion euros). This represents a “significant driver of the high expenditure dynamics,” as the ministry writes. In addition to a very dynamic price component and rising case numbers, nursing staff costs in particular rose again “extremely dynamically” in the first half of the year, by around 10.9 percent (+1.05 billion euros).

The costs for the special sector-equal remuneration or hybrid DRG billing codes introduced in December 2023 are limited. Around 181 million euros were recorded for this in the first half of the year.

Additional spending on medicines

There were also significant additional costs in the supply of pharmaceuticals: spending increased by 10.0 percent (+2.5 billion euros) in the first half of the year, slightly more than in the first quarter. “When interpreting this extremely dynamic development, it should be noted that it is particularly influenced by the expiration of the statutory manufacturer discount, which was increased once in 2023 from seven to twelve percent by the Statutory Health Insurance Financial Stabilization Act,” writes the BMG.

In the first half of 2024, the discounts granted by pharmaceutical companies to the statutory health insurance fell by around 547 million euros. “But even without taking these discounts into account, spending grew strongly by 7.3 percent (+1.94 billion euros). Expenditure on pharmaceuticals in the context of outpatient specialist care is also developing extremely dynamically, showing an increase of around 347 million euros (equivalent to +49.6 percent) compared to the same period last year.

Outpatient services more expensive

Expenditure on outpatient medical treatments increased by 5.3 percent (+1.3 billion euros) in the first half of the year. Expenditure on extra-budgetary psychotherapeutic services showed above-average growth (+6.8 percent or +116 million euros).

According to the ministry, expenditure on outpatient operations according to the AOP catalog also grew more dynamically than the overall sector, with growth of around 9.2 percent (+106 million euros). The health insurance companies booked around 35 million euros for the billing of the so-called hybrid DRG by the practicing physicians.

There was a sharp increase in spending on treatment care and home nursing (+12.4 percent or +569 million euros) as well as on preventive and rehabilitation services (+11.1 percent or +231 million euros). The latter have shown above-average momentum since 2022 following the pandemic-related slumps of recent years.

When interpreting the data for the first half of the year, it must be taken into account that expenditure in many service areas, particularly for doctors, is still based on estimates, since billing data is not yet available or is only partially available, according to the BMG.

The GKV estimation group is now to forecast the development of insured persons, expenditure and income of the GKV for the current and coming year in mid-October. The BMG then wants to announce the new, average expenditure-covering additional contribution rate for 2025 by November 1. The financial results for the 1st to 3rd quarters of 2024 are to be available at the end of November. © may/EB/aerzteblatt.de