TK after the German Reunification (3/4)
In the health insurance sector, too, “reconstruction in the East” was at the top of the agenda. With the reunification, TK returned to its historical roots.
The fall of the Berlin Wall on 9 November 1989 marked the end of the German Democratic Republic (GDR). With the reunification, TK returned to its historical roots: In 1884, the first decisions to establish the health insurance fund were taken in Leipzig. The first head office was located at Markgrafenstrasse 94 in (now former) East Berlin. The eastern cities of Dresden, Halle an der Saale and Magdeburg were among the first sites of the local offices.
Very early on, TK sent the new colleagues to become acquainted with the western German states. In the summer of 1991, there were already 427 full-time and more than 1,000 volunteer employees working in the reunified eastern German states.
At the official start of business operations in the reunified eastern German states on 1 January 1991, TK had 234,795 members from the reunified states. Since the number of members in western Germany had also increased at the same time, TK soon registered its two millionth member.
TK present in all federal states
In 1991, TK established state offices in all of the German federal states. This was a clear signal to the Ministers of Social affairs of the states, who wanted to regionalise social insurance in autumn 1991, which would have almost inevitably led to the dismantling of the nationally operating approved alternative health insurance funds. When the GesundheitsStrukturgesetz [German Health Care Structure Act] came into force in January 1993 and enhanced the role of the federal states within the health insurance system, TK proved to be very well-prepared, thanks to its state offices – and still is today.
TK long-term care insurance
Starting on 1 January 1995, long-term care insurance was established as a new branch of social insurance under the umbrella of the statutory health insurance funds. It was developed as a "partial comprehensive insurance" plan, which means that the funds provided by long-term care insurance cover part of the costs required to care for a person.
Further improvements were made in 2008 through the Pflege-Weiterentwicklungsgesetz [German Long-term Care Enhancement Act]. It is now easier for family members to provide care to relatives who need it. Employees can take a limited amount of time off work to care for their relatives. After all, the majority of people would prefer to be cared for at home in their familiar surroundings.
Not being alone, being safe and well taken care of – that is what many people depend on when they are taking care of relatives or needing care themselves. TK does not abandon its insurees in these situations. This is ensured by the staff in the specialist centres for long-term care benefits, who make certain that care is provided for people who can no longer manage without assistance. They also ensure that those in need of care and their family members receive the benefits they are entitled to.
Insurees are free to choose their preferred health insurance fund
The introduction of the Risikostrukturausgleich (RSA) [risk structure compensation scheme] in 1994 resulted in TK, as a healthy and fiscally strong health insurance fund, becoming the main contributor in the financial compensation system. And, since 1996, members have been free to choose their preferred health insurance fund.
Since its full implementation in 1995, TK has had to pay many billions of euros into the risk structure compensation scheme. Money that was not available for the care of its insurees, but mainly benefited the Ortskrankenkassen [regional health care funds]. Since 2009, the risk structure compensation scheme has also been managed by the allocation mechanism of the healthcare fund. As a result, the billions that some health insurance funds must pay to other health insurance funds as support payments can no longer be disclosed separately – a major lack of transparency in the German healthcare system.
Service for the insurees – and always good care
TK was the first health insurance fund in Germany to go online in 1995. At the beginning of the Internet age, e-mail communication was the central point of the new service. E-mail gave insurees the opportunity to make informal enquiries and also order forms and brochures. Today, TK has a full-service “online branch” on the Internet. And: TK has optimised its entire website for mobile devices, ensuring that the latest TK information is always available quickly, in a user-friendly form and by mobile access, even on the go.
Insurees who register online can update their personal data, order a new insurance card, fill in forms and order brochures. Simply with the click of a mouse. Moreover, they can also apply for benefits and receive reminders for vaccination and check-up appointments.
On 1 March 1995, 371,000 TK-insured women over the age of 50 received a mammography screening. The aim of the procedure is to effectively prevent breast cancer. However, the Bundesversicherungsamt [German Federal Insurance Office] banned TK from covering mammography screenings on the grounds that they exposed women to too much radiation – even though doctors approved of the procedure and experts had no reservations about potential radiation exposure. TK continued to be firmly committed to good preventive care and in 2006, mammography screenings were added to the list of benefits covered by statutory health insurance funds.
Since 1996, insurees have been free to choose their preferred health insurance fund
Techniker Krankenkasse was an occupational health insurance fund for technicians, engineers and architects for a long period of time. This changed fundamentally in 1996 as a result of a health care reform. Since then, insurees have been free to choose their preferred health insurance fund. With this reform, the legislators intended to promote competition between the various health insurance funds. The aims for the insurees were better service and better care at lower costs.
Following the reform that allowed insurees to choose their preferred health insurance fund, TK was open to all occupational groups. The identity of TK was at stake. For this reason, the decision of the legislators was not initially fully endorsed by TK. Although it was essentially positive about social innovations, TK was concerned that, among other things, it would lose its distinct profile as an occupational health insurance fund once it started accepting insurees from other occupational groups.
However, membership trends showed that these concerns were completely unfounded.