Fritz Müller: The demographic change as a challenge for statutory health insurances

The health care sector is facing huge chal­­lenges. Both demographic change and progress in medicine will bring with them considerable changes and present all stakeholders with new roles. The health care sector is moving towards treating more and more elderly patients. The health care needs of the population will increas­ingly be shaped by chronic illnesses, the need for nursing care and dementia in the coming decades. At the same time, pro­­gress in medicine will unlock new treat­­ment options, although the effectiveness and benefits of these are not always im­­mediately verifiable, and may even be in doubt. The key here is to find the right balance between promoting innovation and ensuring patient safety.

At AOK Hessen, providing good health care for our policy holders is very impor­­tant to us. Even today, our “Curaplan” range offers pioneering health care programmes for chronically ill patients and integrated health care contracts for se­­lected diagnoses, alongside regular health care services. As well as caring for those who are ill, as a health insurance provider, we are also always keen to provide preventative measures. Encouraging people to live healthy lifestyles is one of our key roles. This starts with special services for pregnant women, and also includes check-­­ups for children and our “Papilio” preven­tative programme for nursery schools. Our work for older children and young people includes working together with schools and clubs, such as in our “AOK MOVES YOU” competition for schools and our “AOK-Pausenliga” (AOK break time league) programme in cooperation with Eintracht Frankfurt. For adults, we offer an extensive programme of classes and a wide range of information and partici­pation programmes online, as well as apps such as the “AOK-Vorsorgemanager” (AOK check-up manager). Company health promotion programmes provide the fin­­ishing touch to our range of preventative measures.

Statutory health insurance (SHI) has a central role to play in overcoming the twin challenges of quality-assured patient care and preventing diseases. Around 85 per cent of the German population holds stat­­utory health insurance. As the largest health insurance corporation in Germany, we invest around EUR 66 billion in the health of our policy holders every year – our budget for 2013 was over 4.5 billion euro in Hessen alone. But we do not see ourselves merely as those footing the bill. Instead, “we are a strong insurance pro­­vider and shape routes to health” is the standard that guides our company’s vision.

Competition and solidarity – for efficient health care for everyone. A competitive and united health care system provides the best conditions for facing the challenges of the future. However, competition in health care cannot be an end in itself, and clear rules are needed to guarantee that everyone is able to afford to protect themselves if illness occurs. We absolutely reject selecting policy hold­­ers on the basis of risk.

This means that, on the one hand, health insurance providers are not allowed to gain structural competitive advantages simply by targeting young, healthy policy holders, while on the other, there must be a social function for balancing different levels of income. The health care fund safeguards both aspects by allocating mor­­bidity-based funding to the health in­­surance providers. This funding has formed the central financial architecture of SHI since 2009. Illness-related allocations from the health care fund ensure that health insurance providers receive fund­­ing in line with the medical conditions of their policy holders.

Combining all SHI’s financial resources in the health care fund also means that all discrepancies in income are ironed out. This means that the crucial factor in the financial situation of a health insurance provider is no longer its policy holder structure – as it was to a large extent be­­fore 2008 – but the question of how well and economically a health insurance pro­­vider secures health care provision for its policy holders – i.e. the health insurance provider’s management skills. This has created the foundation for competition based on solidarity, benefiting both patients and those who pay contributions – employees and employers.

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Quality and economic efficiency – two sides of the same coin. The AOK Hessen’s most important goal is therefore to pro­­vide quality-assured, premium and eco­­nomical health care at a competitive price – and all of this combined with excellent service. This forms the foundation of our overriding company goal: increasing the number of policy holders. Both factors – good services and a com­­petitive price – are essential if we are to consolidate and expand on our position as the top health insurance provider in Hessen.

If quality and economic efficiency are to improve in the health care sector, health insurance providers need to be given more competitive options when it comes to contractual relations with service pro­­viders. In the hospital sector in particular, additional options must be created to allow contracts to be concluded with individual institutions based on a quality aspects.

Health navigator. People today want to decide autonomously and on their own initiative – especially when it comes to their own health. That is why the AOK Hes­­sen sees itself as a navigator in all health care issues. Quality-assured information and advice services allow our policy holders to gain targeted information and use it as the basis for choosing the right treatment together with their doctors or health care professionals. Our range of in­­formation services includes online plat­­forms such as our hospital, doctor and nursing care navigators, special apps with health tips and personal advice either at home or at the place of treatment. Our nursing care advisors, for example, provide essential assistance in issues of social law when relatives are faced with caring for a member of their family.

Staff are the key to success. Qualified and dedicated staff are a crucial factor for suc­­ceeding in competition. Systematic staff development is therefore an indispensable part of our company’s focus. This staff development also includes diversity management, which develops answers to the question of how the differences between our members of staff can be put to the best possible use so that we can all succeed together. Finding the right balance between work and family or caring for a relative is a key topic here, and one that is affecting an increasing number of employees. New management models are helping to allow even part-time staff to lead an area of responsibility independently.

With their professional expertise and per­­sonal dedication, our staff have made the most important contribution to making the AOK Hessen’s top health insurance provider.

 

Fritz-Müller1-KopieOur author was born in 1948 and holds a Diplom degree in public administration. In the year 1979, Müller became the man­­ager of the finance and contract division of the AOK in Wetzlar. After work­­ing in several other leading positions in Lahn-Dill and in Mühlhausen in the north of the federal state of Thuringia, he changed to the management of the AOK Hessen in 1993. Since 2002, Fritz Müller has been the CEO of the AOK Hessen.