The Transformation of the Social Right to Healthcare by Katharina Böhm

Author:Katharina Böhm [Böhm, Katharina]
Language: eng
Format: epub
Tags: Social Science, Sociology, General
ISBN: 9781317013532
Google: jQpqDAAAQBAJ
Publisher: Routledge
Published: 2016-06-17T03:23:17+00:00

Generosity – cost coverage

The Kohl government instituted a massive increase in co-payments. In order to reduce the cost burden for the most vulnerable, exemption policies were completely reformed. Formerly, the definition of ‘hardship case’ for exemption from co-payments had been left to the discretion of each health fund. With the changeover from RVO to SGB V in 1989, eligibility criteria for the exemption from co-payments were united within one regulation that applied to all SHI funds. The SGB V differentiated between full and partial exemption. Full exemption from all co-payments for pharmaceuticals, remedies, medical aids and appliances (including optical appliances), dental appliances, hospital treatment and all travelling costs was granted if the patient would have suffered an ‘unacceptable burden’ from co-payments (§ 61 SGB V). An unacceptable burden was determined to exist in cases of low income or the receipt of other social benefits (e.g. unemployment allowance). If the conditions of full exemption were not met, co-payments for pharmaceuticals, remedies and traveling costs had to be borne, up to a certain threshold, by the patient (§ 62 SGB V): low income earners had to make co-payments until the sum of co-payments reached two per cent of their income; for high income earners, a maximum threshold of four per cent of income applied. Children and young adults were generally exempted from paying charges. The 1.GKV–NOG (Art. 1 No. 1) amended the maximum co-payment threshold by switching the eligibility criterion from income to disease: a general threshold was set at two per cent of income for all income groups; only for patients suffering from a chronic disease did a lower threshold of one per cent apply.

The first and second SHI Restructuring Act implemented several reforms addressing cost coverage that never took effect because they were abolished by the new government directly after it came into office. First, the 2.GKV–NOG (Art. 1 No. 19) provided for an automatic increase of co-payments for preventive and other regimens, pharmaceuticals, stationary rehabilitative services and traveling expenses as of 1.1.1999. The amount of the yearly increase was thereby determined by the increase in aggregated wages. Second, co-payments were pegged to the contribution rate: increases of the contribution rate of 0.1 percentage point caused all absolute co-payments to rise by 1 DM and all relative co-payments by one per cent (Art. 1 No. 4 1.GKV–NOG). Third, SHI funds were allowed to individually increase co-payments for their members (Art. 1 No. 15 2.GKV–NOG).

Primary care and specialised ambulatory care: In the course of the introduction of ambulatory psychotherapy by psychotherapists (see above), a co-payment of 10 DM per session for adults was introduced in 1996. For these co-payments, another maximum threshold of two per cent of the patient’s income for the first, and one per cent for the following years was set. Children were exempted from paying charges, as well as pregnant women and young mothers, if their need for psychotherapy was related to their pregnancy or the birth of their child (§ 62 (1a) SGB V introduced by Art. 1 No.

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