Consultation fee: Statutory health insurances complain about unequally distributed compensatory financing

With the consultation fee falling short as of 2013, health insurers are now afraid that compensatory financing from the national health fund will not compensate for the lack of funds. Siemens Betriebskrankenkasse (Siemens‘ company health insurace fund) advises against distortions resulting from compensation via the national health fund.

In order to avoid financial problems resulting from the shortfall of the consultation fee Germany’s federal government has announced a compensation payment via the national health fund. This is a ground for complaint since the compensation is coherent with regards to all health insurers but not necessarily with regards to a single insurance company.

Comment: The morbidity-based risk structure equalisation fund has catched a lot of flak since its implementation. Only recently, several health insurance companies wanted to bring the matter of internal financial compensations to trial. Now, the shortfall of the consultation fee fuels the discussion again. This time the (company) health insurance funds feel economically disadvantaged by compensation payments via the national health fund. The criticism coming from the insurance companies that morbidity is not an appropriate criterion for calculating compensation is comprehensible. Because morbidity cannot be related to the revenues coming from the consultation fee. Therefore, the company health insurance funds prefer the individual revenues resulting from the consultation fee as a criterion.

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