15.5% of gross monthly wages in Germany deducted for Health Insurance

Germany repeals €10 quarterly charge for visiting the doctor
BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7670 (Published 12
November 2012)
Cite this as: BMJ 2012;345:e7670

Germany’s Bundestag, the lower house of parliament, has unanimously
voted to repeal the so called “medical practice fee,” which requires
patients aged 18 years or older who are insured by the nation’s public
health insurance system to pay a €10 (£8; $13) charge for their first
visit to the doctor in each calendar quarter.

The charge, collected at doctors’ and dentists’ offices, is then
funnelled into the public health insurance system, which covers more
than 90% of the population. Since 2004, when the fee was created
partly to discourage unnecessary visits to the doctor, the charge has
netted nearly €2bn a year.

Public health insurers have been strong supporters of the €10 charge,
while the German Medical Association and other doctors’ organisations
have opposed it. Doctors have said that the charge was a financial
burden to lower income patients and a time consuming and “unnecessary
bureaucracy” for doctors. It also seemed to reduce the number of
visits patients made to doctors.

With a large portion of the public against the €10 charge and with
German federal elections scheduled next year, doctors’ organisations
in the past year have increased efforts to force its repeal. In May
the National Association of Statutory Health Insurance Physicians
(KBV) began a nationwide petition, collecting signatures of 1.6
million patients opposed to the charge by the end of October. The
association held a press event to deliver the signatures to Germany’s
health minister, Daniel Bahr.

Party leaders of Chancellor Angela Merkel’s coalition government
agreed to repeal the charge last week. Within two days all major
opposition parties voiced their support for repeal, setting up the
vote in the Bundestag. The repeal takes effect on 1 January.

Doctors’ groups applauded the decision, noting that public insurers
were sitting on historically high cash reserves. In 2011 the insurance
system had costs of around €180bn but revenue of around €184bn, mostly
through the monthly premium of 15.5% of gross monthly wages of insured
people. In September, after the public health insurance system
reported a surplus of €2.7bn in the first half of 2012, Bahr indicated
that reserves were too high and urged public insurers to issue rebates
to members.1

The National Association of Statutory Health Insurance Funds, which
represents Germany’s public health insurers, responded by saying that
the eurozone was facing financial risks and that building up reserves
for potential “difficult times” was justified.

The association has now criticised the repeal of the €10 charge,
warning that the resulting loss of €2bn a year to public health
insurers would eventually have to be recouped by other means.

“The decisions of the government will allow the reserves of public
health insurance to melt like snow in the sun,” said Doris Pfeiffer,
the association’s chairwoman.

Dieter Hundt, president of the Confederation of German Employers’
Associations, also criticised the repeal of the charge for doctors’
visits and described the charge as “sensible,” adding, “The repeal of
the charge is a huge mistake.”