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In Germany, health insurance is compulsory. About 90% of the citizens are covered by statutory health insurance (Gesetzliche Krankenversicherung), whereas the other 10% are covered by private health insurance.

Is the high percentage of people covered by the statutory health insurance necessary to keep the cost of the health care system on a reasonable level? How would spendings on health care change, if 60% were privately insured and only 40% were covered by statutory health insurance?

  • I removed the last sentence of your question because it was a completely different question about a completely different country. Please try to keep your question reasonably scoped. You might want to ask about health care in the United States as a separate question. – Philipp Feb 2 '17 at 13:52
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    Regarding the main question: What "cost" do you mean? The cost for the government, the individual insured citizen, the employers or the overall amount of money spent on health-related services and goods? Also, which 60% of the population exactly do you want to insure privately? This is important because rates for statutory health insurance depend on the income of the insured person while those for private health insurance do not. – Philipp Feb 2 '17 at 14:01
  • Concerning the cost, I am mostly interested in cost for individual insured citizen and the government? And suppose that the 60% of the population are a "cross section" of the society. – Lukas Feb 2 '17 at 18:20
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It depends on what legislation affects the private sector.

Say the private sector can turn away people with genetic defects and the like, that is specifically those more likely to have larger medical bills throughout life or people who are already chronically ill.

Or say they can turn away daredevils who do lots of snowboarding or whatever sport gets you hospitalised most.

If private insurance then holds 60%, it will result in the 40% percentually holding more of the high cost individuals, thus increasing costs for all those paying their share.

If this is however prevented via legislation, then private health insurance companies holding 60% will only affect the remaining 40% via statutory health insurance instances still having costs that don't go down with less people to keep track of in their system.

For example the members of the IT staff still need to be paid for keeping the network running, servers & thus privacy of the citizens secure, develop the website and will normally still be needed as much as before for these tasks.

But the question is, of course, how much this actually will amount to.

That said this question and this answer can really be equated to a typical red herring. In reality the sum of many more questions and answers is needed before one can estimate the reality of private vs statutory health insurance.

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  • I don't believe daredevils are much of an issue; even if medical care was free most of the people don't enjoy broken bones and the like. Also, the typical trauma costs (barred paralysis) should be relatively low when compared to, say, cancer and AIDS treatment. – SJuan76 Feb 2 '17 at 15:35
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    @SJuan76 - that point makes sense, but it's more extreme example. There are more impactful ones, on the same principle. There are people who endanger their health as a matter of habit, from liefestyle obesity (yes, some obese people are that way due to genetics beyond their control - but some are due to not bothering to put in effort); drinking; drugs; getting into fights, not washing hands in bathrooms, etc... I have heard many stories about people going to ER because they didn't bother with basic care regarding their diabetes. – user4012 Feb 2 '17 at 15:49

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