In Germany, more and more people are opting to leave the state-run health insurance plans. But those who do so are taking on the risk of going bankrupt paying for medical treatment.
Pay-as-you-go operations? More Germans are risking it
The possibility of opting out of public health insurance -- thereby saving several hundreds of euros each month -- is tempting for many.
Increasingly, people who are self employed or run small businesses and find themselves in financial straits are taking advantage of this option, the German Health Ministry recently said.
More and more uninsured
Since 1995, the number of self employed people that have neither state run nor private insurance has risen from 6,000 to 31,000 in 2003. This agrees with a nationwide trend; some 188,000 people (whether self employed or not) had no insurance in Germany in 2003, up from 105,000 in 1995.
While these numbers are relatively small, economists note than in neighboring European countries, the phenomenon of being uninsured is unknown. And they warn of a US-like system which leaves huge numbers of citizens uninsured.
Karl Lauterbach (right) and Bert Rürup, who headed a governmental commission to come up with health care system reforms
"The possibility of entirely avoiding the solidarity system of health insurance simply doesn't exist in the other EU countries," Karl Lauterbach (photo, right), an economist who advises the German government on health care policy, told DW-WORLD. "Actually, in the Netherlands you can get out of the compulsory state insurance system. But then you are obligated to buy private insurance."
Data from 2001 assembled by the Organization for Economic Cooperation and Development, or OECD, show that the national health care systems in all of the then-member states guarantee basic health coverage, while in Germany just 90 percent of the citizens were insured via the state-run system. And the percentage of uninsured among the remaining 10 percent continues to grow.
In Germany, there are laws governing who is eligible for state-run health insurance. Most employees and their family members must buy into an insurance plan. Students and people in job-training schemes -- with few exceptions -- also need to be insured.
"But compulsory insurance according to the law doesn't apply to every citizen," Lauterbach said.
In general, those who are self-employed are exempt from compulsory insurance. Whatever their income level, they have a choice of buying a state-run insurance plan, buying a private plan -- or saving the money and going without insurance altogether.
Top earners can opt out
Even company employees can opt out of the state run insurance schemes if the earn enough money to do so. The current upper limit for compulsory insurance is a salary of €3,862 ($4,750) per month. Anyone who earns more than that can opt out.
This opt-out option presents a twofold risk, Lauterbach said.
Even with insurance, healthcare clients still have to shell out a copayment
"On the one hand the groups engaged by the state to provide insurance lose premiums," he said. "On the other hand, the costs of illness have gotten so high that no one can afford to pay them alone."
Even people who earn very high salaries are effected when they opt out of insurance altogether, he said.
Mess in the US
Lauterbach cited the United States as an example of the risks both individuals and society can take when health care is privatized. Some 120 million US citizens -- 40 percent of the population -- are either uninsured or underinsured. Of these, 44 million have no insurance protection whatsoever, while the rest are only partly insured.
"Many US citizens can't afford adequate insurance and thus don't get insurance for illnesses they may already have," Lauterbach said.
Another case in point is the young, healthy Americans who are in the middle of building up companies and families. "They often have to opt to be uninsured purely on the basis of cost," Lauterbach said."Then if they get sick, it can lead to them losing their business."