Two-tier health care

" Two-tier medicine" is a negatively occupied a political slogan. It refers to a health system in which the quality of medical care depends on whether the patient is legally ( " evaluations " ), or private health insurance.

Discussion in Germany

In the political discussion in Germany, the term is often referred to ( by different stakeholders) for the different performance demands of the statutory health insurance scheme (GKV ) compared to private health insured (PHI ) patients. Private health insurance, the argument goes, would thus have a better medical care and shorter waiting time for doctor's appointments.

The different according to various statistical surveys life expectancy of law and privately insured patients is performed as evidence of the negative effects of a two- tier health system in the field. Often while a possible causal relationship, however tacitly implies ( "Because you are poor, you have to die sooner. " ), Which is not mandatory and would also be difficult to detect. For example, to take into account that wealthier populations often are also more educated and therefore also behave more health conscious, which in turn can have a positive impact on their life expectancy.

In contrast to the public debate in recent years can be seen from a representative Forsa survey of 1,005 insured on behalf of the IKK classic that only 9 percent of respondents towards " second-class medicine " complain. The survey showed about fast appointments and long waiting times similar results.

Multi-class medicine

Partial is also spoken by the three- tier health system, which divides in statutory health insurance, statutory health insurance with additional insurance and private insurance. In the statutory health insurance benefits on the one hand marginalized (eg § 28 SGB V), or limited to usually limited supplies (eg, fixed subsidies for dentures ) or by the efficiency principle. This includes all services that infringe the efficiency principle in accordance with § 12 Section 1 of the SGB V, thus exceeding the criteria of the kind. The wording of § 12 para 1 of the SGB V is this:

" The services must be sufficient, effective and economically; they must not exceed what is necessary. Services that are not necessary to ensure that members can not claim, providers must not result and not approve the health insurance companies. "

Privately insured can in turn be divided into

• Insured in the basic rate
• Insured in the open only to certain groups of people defined by the legislator standard tariff
• Insured in the emergency tariff
• Private student health insurance
• Private insurance part for aid beneficiaries
• Private health insurance for self-employed
• Private full health care coverage for employees with incomes above the social security ceiling

The scope of services of the said private insurance companies vary greatly, resulting in a " multi-class insurance " and consequent " multi-class medicine " results. The claim that only the wealthy ( " better-off " ) are private healthcare insurance is not preserved:

• 48% of private health insurance are lower and mid-level officials ( and their relatives ).
• 20 % are self-employed. Status of self implies not a high income. The same is true for students.
• 20% of the privately insured are children.
• 12 % are employees on compulsory insurance limit.
• The base rate equal to the scope of the statutory health insurance.

The PHI is for self-employed with low income (eg start-ups ) also interesting because the income is generally determined in the case of self-employment after the fact, if the actual income and expenses are fixed. The cost of private health insurance are thus easier to calculate than in the SHI.

In total, more than 9 million people are privately insured ( 11.3%). The number of private supplementary health insurance is 22.6 million, including 13.3 million dental insurance.

The correct umbrella term against the insured patients with benefits in kind would be " self-pay " for all privately claimed medical and dental services are to be paid initially by the patient himself. Meanwhile refund claim depends on the nature of its private health insurance and the chosen tariff.

Discussion in Austria

After a long discussion in Austria, which employs the media, a KAKuG amendment is in the legislative process. Hospitals should lead a mandatory, transparent waiting times management in the future in all of Austria. The waiting list for regime comes compartments with a particularly high number of interventions can be planned:

• Ophthalmology and Optometry
• Orthopedics, orthopedic surgery
• Neurosurgery.

Anonymously will be seen in the future, how long you have to wait in a hospital on a certain operation. The special class patients and patients must be made visible. Within eight months after the decision, the wait time management must be implemented. The transparent waiting time management should be an efficient measure against a two - tier health system. It should be excluded that patients are pre- lined with special insurance.

The Austrian Insurance Association (VVO ) warned of the " classless hospital " and designated private patients as " not to miss, massive support" for the hospital system. As a " double standard " referred to the Deputy Federal Chairman of the staff doctors in the Austrian Medical Chamber ( ÖÄK ), Robert Hawliczek, the outrage over the alleged two-class medicine in operations against cataracts. " Private additional insured patients bear with well over a billion euros crucial year to financing Austrian hospitals in ".

Discussion in Switzerland

In Switzerland, the two-tier medicine is controversial among experts and the media. The health economist W. Oggler: " second-class medicine has always existed and will always exist. The question is, at what level the second class is ".

F. Mathwig favor of a Justification of differences of treatment and refers to Aristotle, according to which the same equal, unequal should be treated differently.