This photo from November 9 shows the headquarters of Techniker Krankenkasse (TK), one of the largest German statutory health insurance companies, based in Hamburg. Korea Times Photo by Lee Hyo-jin
Health insurance industry is recovering from the COVID-19 pandemic with adaptive strategies
By Lee Hyo-jin
BERLIN, Germany – By 2022, 17 percent of Korea’s population of 51.6 million will be age 65 and older. According to projections made by Statistics Korea, the figure is expected to rise to 20 percent in 2025, making the Asian nation a super-aging society.
The country’s fertility rate – the average number of children a woman gives birth to in her lifetime – hit a new low of just 0.78 in 2022, well below the 2.1 threshold needed to keep the population at current levels.
Many of the consequences of the country’s rapidly aging population and low birth rate have increased public expenditure Health care is a matter of concern for the Korean government.
The government is struggling to find long-term solutions to deal with the looming financial burden of the country’s universal health coverage system run by the National Health Insurance Service (NHIS).
However, such phenomenon is not limited to Korea only.
European countries with strong health insurance systems, such as Germany and Belgium, are facing similar challenges. These wealthy nations are also grappling with increasing financial pressures on social security and public health services due to a combination of increased life expectancy and a shrinking workforce.
A series of interviews with health insurance industry executives and a lawmaker based in Germany and Belgium, conducted between November 6 and November 12 by Korea’s Ministry of Health and Welfare, offered an insightful glimpse into how they are trying to find answers. are doing. This issue.
Thomas Schepp, right, head of strategies and control, and Stephanie Bosch, head of communications department at BKK Deutschverband, speak during an interview at the company’s office in Berlin on November 7 (local time). BKK Dachverband is the leading organization of company-owned health insurance providers in Germany. joint press corps
Germany’s health insurance is based on solidarity, competition
Germany is widely known as the birthplace of social insurance. The world’s first health insurance scheme – modeled on Solidarity – was established in 1883 with Bismarck’s Health Insurance Act.
Currently, all citizens and foreign residents are obliged to subscribe to the health insurance system under the Health Insurance Compulsory Law enacted in 2009.
About 90 percent of the country’s 83 million population are covered by the public health insurance scheme, known locally as Gesetzliche Krankenversicherung (GKV), while the other 10 percent, such as high-income workers and the self-employed, People are covered by a private health insurance. System, or Private Krankenversicherung (PKV).
The basic premium rate for public health insurance is 14.6 percent, which is shared between employers and employees at 7.3 percent respectively. Contributions are automatically deducted from the monthly salary of the insured. Each insurance provider may charge an additional contribution rate – a maximum of 1.6 percent – for supplemental benefits beyond the legally prescribed list.
A key aspect that differentiates Germany’s health insurance scheme from that of Korea is that unlike Korea, where the NHIS is the sole insurer, the European nation has approximately 100 self-governing insurance corporations within the public health insurance scheme.
This way, people can “shop around” to find the best deals depending on what type of coverage they need. German officials say the system aims to improve the overall quality of medical services through competition between service providers.
“There are big companies like Siemens that have about 1 million customers, and then there are smaller companies that have about 4,000 customers. But that doesn’t mean the smaller guys are financially unstable,” said Thomas Shepp, who manages the strategies. controls the In BKK Deutschverband, the leading organization of company-owned health insurance.
Thorsten Brackert, head of corporate development at Techniker Krankenkasse (TK), speaks during an interview at the company’s headquarters in Hamburg, Germany, on November 8 (local time). joint press corps
proactive immigration policies
In the long term, Germany has recognized the potential role of immigration in helping to cope with the financial burden caused by increased public health expenditure due to the impending demographic crisis.
By accepting immigrants – especially those of working age – the country seeks to increase the number of contributors to both the social security and health insurance systems.
“Right now, I can’t give you exact figures as to how much immigrants are contributing to the financial sustainability of the public health insurance scheme. But I can say that the migrant flow from Eastern Europe inspired by the 2008 financial crisis has brought positive effects (to the public health insurance scheme),” said Schepp at BKK Dachverband.
Executives at Techniker Krankenkasse (TK), one of the largest Hamburg-based health insurance providers, also believe that active immigration policies are the best answer to be able to respond to the demographic challenge.
Thorsten Brackert, head of corporate development at TK, said, “We may consider increasing the additional contribution rate… but for now, immigration policies attracting young migrants will somewhat slow the pace of population aging. Have been.”
Korea, a predominantly homogeneous country, is looking for skilled migrant workers revive his stammer economy.
Nevertheless, when it comes to foreign nationals in the public health insurance scheme, Korea’s NHIS has struggled with the increase in the number of foreign nationals who have exploited the system in recent years.
Under current laws, salaried workers of foreign nationality wishing to apply for Korea’s NHIS coverage are required to have resided in Korea for at least six months, sign up for the program through their employers, and pay monthly premiums. Is.
But their dependents – spouses, children or immediate family members – are not subject to such requirements and are thus eligible to sign up regardless of length of stay here, as long as they meet certain criteria such as income and assets. Let’s complete. There have been several cases in which foreign family members, including parents of customers, have visited Korea to receive health insurance benefits such as treatment and surgery despite not living here.
Regarding the potential for exploitation of the German health system, Brackert said, “I would not say that such a problem does not exist in Germany. But I think this is not a big issue here because foreign nationals have to live here for at least several years to become eligible for all the health insurance benefits offered.”
Impact of Covid-19
Asked about the impact of the COVID-19 pandemic on the country’s health care expenditure over the past few years, Shepp replied that the pandemic has dealt a heavy blow to health care-related public spending, but fluctuations with.
“While costs associated with the pandemic response have increased, spending on non-essential health care services related to physical therapy and routine medical checkups has inversely decreased,” he said.
Nezahat Baradari, a Social Democratic Party lawmaker and member of the health committee, speaks during an interview in Berlin on November 7 (local time). joint press corps
Nezahat Baradari, a Social Democratic Party lawmaker and member of the health committee, introduced some of the legislative efforts made by the German Parliament to deal with the deficit of the statutory health insurance system, which has been stretched thin due to the prolonged COVID-19 pandemic. Had become intense.
The GKV Financial Stabilization Act, which came into force in November 2022, aims to reduce spending on pharmaceuticals and address drug supply shortages.
“Due to the COVID-19 pandemic, there is considerable pressure on health insurance budgets. But since it is difficult to raise insurance premiums, legislation has been enacted to cover pharmacies and the pharmaceutical industry,” he said.
He further said that cost-control measures implemented under the newly introduced law have reduced the funds allocated to pharmacies and drug manufacturers.
“Pharmacy associations strongly opposed this, but if we had not taken such steps, our health insurance system would have collapsed,” Baradari said.
Thierry Delestrete, an official in the financial department of the National Institute for Sickness and Disability Insurance (NICHDI), explains the institution’s budget data during an interview at its headquarters in Brussels, Belgium, on November 9 (local time). joint press corps
Health insurance is also mandatory in Belgium, a country of about 12 million people. The public insurance system is managed by the National Illness and Disability Insurance Institute (NIHDI). However, unlike Korea’s NHIS, NIHDI does not directly handle insurance benefits, but is responsible for its overall management.
Every Belgian resident is obliged to select and register with a specific health insurance fund, commonly called a “mutuel”. These non-profit organizations, six in total, operate independently based on political and religious backgrounds such as socialist, Christian, and liberal.
People can opt for one of these associations to pay insurance premiums, which guarantee reimbursement of most medical, drug and hospital-related expenses.
Speaking to The Korea Times, Thierry Delstrate, an official in the financial department of the NIHDI, explained that his institution, which oversees a budget of three billion euros, involves all stakeholders in the budget decision-making process to ensure stability related to financial management. Actively involves relevant stakeholders. ,
Regarding the effects of the prolonged COVID-19 pandemic, Delstrate said, “About 30 different COVID-19 measures were introduced during the pandemic. Our primary focus is on more The number of hospital beds had to be increased to accommodate more patients, which obviously increased medical costs.”
He said predicting the future financial performance of health insurance has become more challenging because of the pandemic.
“But the good thing is that we plan to continue to use some of the positive sides of the pandemic response measures, such as face-to-face consultations and remote health care systems.”
(tagstotranslate)financial
