Stand: 16.09.2020
Different Health Systems: GKV & PKV
Despite the differences between statutory and private health insurance, Germany has one of the best healthcare systems in the world. Internationally, we benefit from short waiting times, free choice of doctors, and medical advancements. Doctors and hospitals are available nationwide. As the saying goes, competition drives quality. This makes it significantly harder for statutory health insurers to enforce service reductions.
How Does Insurance Work?
In general, both systems work similarly. All members pay a monthly contribution into a "pool." This pool belongs to the community of insured members. If someone gets sick, the costs are paid from the community pool. This means the healthy pay for the sick. Insurers always act solidarily for their group.
Differences Between GKV & PKV
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GKV |
PKV |
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Benefit-in-Kind Principle: · Doctors bill the insurance directly · Physician compensation decided by the Assessment Committee (BA) · Billing according to the Uniform Value Scale (EBM) · Scope of benefits governed by statutes, can be changed at any time |
Reimbursement Principle: · Doctors bill the insured directly · Costs regulated by Fee Schedule for Doctors & Dentists (GOÄ / GOZ) · Typically billed 100–200% higher than in GKV · PKV reimburses the billed amount · Scope of benefits contractually guaranteed |
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Pay-as-you-go Principle: · Young and healthy finance the old and sick · High earners pay for low earners · Singles pay for families · Problem: How can so few young people support so many older people? (Demographic Pyramid) |
Capital-funded Principle: · Healthy finance the sick · Each generation or plan saves independently for old age · Legal requirement: 10% reserves must be built for old age (§ 149 VAG) · Optional contribution relief plans can be added |
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Benefits: · Governed by Social Code (SGB V) § 12 SGB V: · Sufficient (grade 4) · Appropriate (simple) · Economical (cheap) · Necessary (unavoidable) |
Benefits: · Free choice depending on plan - performance or cost-efficiency · Free choice of doctor · Free choice of hospital · Billing also via GOÄ · Latest medical treatments possible |
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Here you can find the differences in benefits between GKV & PKV |
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GKV Contributions · Income-based up to Contribution Ceiling (BBG) · Non-working family members can be co-insured for free (§ 10 SGB V) · Additional contributions: extra payment by insured (since 2015) |
PKV Contributions Contributions are individual and independent of income. Factors affecting contributions: · Entry age at start · Health status at application · Profession (e.g., poker players usually not insurable) |
