PKV vs. GKV: Who protects better against the health financial shock?

PKV vs. GKV: Who protects better against the health financial shock?

Jan Esser, the chairman of the board of Allianz Private Krankenversicherungs-AG, presented the advantages of private health insurance (PKV) in comparison to statutory health insurance (GKV) in a recent interview. In times of rising healthcare costs, Esser sees private health insurance as the better choice because it offers contractually guaranteed healthcare. The cost increases in both systems are primarily due to inflation and medical progress. At the same time, he points out that PKV enables generation-appropriate provision for constantly changing health costs, while GKV relies on a pay-as-you-go system that uses current income for current expenses.

Due to the ongoing financial challenges, the maximum contribution in the GKV has risen from 1,050 euros to around 1,174 euros, which means a monthly increase of 124 euros. Despite these rising costs, many people with private health insurance ultimately pay less and at the same time enjoy better services. With regard to transparency, Esser points out that premium increases in statutory health insurance are often not clearly communicated, while those insured by private health insurance are informed about adjustments.

Differences between PKV and GKV

A central point of Esser's argument is the different ways in which the two systems handle resources. While the GKV can currently hold reserves for around five to six days, the PKV providers are able to guarantee reserves for over nine years. This ensures greater stability and planning security in the medical care landscape. Esser also calls for it to be easier for people over 55 to return from private health insurance to statutory health insurance, but advocates for an extension of the standard tariff as part of this solution.

A further aspect that Esser addresses is the disincentives in the German healthcare system. These include a high number of hospital beds and extended lengths of stay, which often lead to unnecessary treatments. He also emphasizes that privately insured people contribute around 14.5 billion euros more to the health system every year than legally insured people, which promotes the economic stability of the practices.

PKV’s innovative strength

Esser also emphasizes that PKV acts as a driver of innovation, as doctors can use innovative treatment methods for privately insured people without lengthy approval processes. This competition between the two insurance systems promotes the rapid integration of new treatment and diagnostic techniques that ultimately benefit patients. German patients benefit more quickly from new cancer drugs compared to other European countries. A study by Prof. Dr. Jürgen Wasem supports this claim by confirming that the private health insurance reimburses medical innovations more quickly than the statutory health insurance.

As an example, Esser cites the approval of shock wave therapy for heel pain in the GKV, which was only implemented in 2019. In contrast, the PKV reimbursed this treatment in 2002. This faster reimbursement by the PKV ensures that methods that are not included in standard care have to provide greater justification, which benefits the entire health system.

Esser himself speaks out against the introduction of citizens' insurance, which, in his opinion, would jeopardize the advantages of private health insurance. Many state-of-the-art therapies and treatment options could be lost under a uniform reimbursement system. A waiver of private health insurance would therefore entail considerable restrictions for patients.

Overall, Esser affirms that everyone in Germany, regardless of insurance, has access to necessary medical care. Nevertheless, the debate about the sustainability and intergenerational equity of the various systems remains a highly topical topic. While the PKV has advantages in the provision of services, the GKV ensures broader social security.

For more information you can visit the article Focus Online and the positioning of the PKV read.