Indicators of Financial Developments in the Statutory Health Insurance System and their Normative Implications

Per capita spending, though, reveals a different picture. Every year since 1991, expenditure per insured person has risen by an average of around 1 percentage point more than per capita income on which SHI contributions are payable. This difference remains even when both values are related to the SHI members paying those contributions. Per capita SHI expenditure has also been growing disproportionately fast compared with potential consumption, described by gross national income per head of population. On the other hand, there has been no erosion of the statutory health insurance’s financial footing. Income subject to contributions per SHI member has developed approximately in line with employees’ average pay. However, per capita national income has grown somewhat more steeply. These findings thus provide clear guidance on whether to give preference to a revenue- or an expenditure-based health policy. A reform of contribution financing may seem opportune in terms of distribution policy, but would not solve the urgent problems on the expenditure side.