Duplicate structures in the healthcare system
Statutory accident insurance with the employers' liability insurance associations and accident insurance funds should be abolished because it perpetuates expensive duplicate structures. In the case of commuting accidents and accidents at work, compulsory health insurance can already cover treatment costs just as well without any additional expense. No additional insurance is therefore necessary here. The prevention and insurance of occupational illnesses could also be handled by health insurers, as they already have expertise in health and treatment issues and contacts with healthcare providers. Additional capacities in this area could easily be provided by the persons currently responsible for this at the employers' liability insurance associations. The actually necessary monitoring of appropriate measures in the area of accident prevention should be taken over by the trade supervisory authority. The services of the existing accident insurance could thus be provided much more efficiently without the need to set up new structures.
The savings potential, on the other hand, is high. Companies currently pay an average of 1.3 percent of each employee's gross salary to the employers' liability insurance associations. In addition, there are tax subsidies of around 1.8 billion euros per year for the state accident insurance funds. According to data from the Federal Ministry of Labor and Social Affairs, total expenditure in the accident insurance system amounted to 16.7 billion euros in 2022.1 This includes around 1.7 billion euros for administrative costs and a further three billion euros for capital expenditure and other expenses.
The abolition of the very small-scale structures - particularly in the state accident insurance funds - would save a considerable amount of administrative costs. However, with the processing of occupational illnesses, the most financially costly area would have to be transferred to the statutory or private health insurance funds, whose contribution rate would then have to rise slightly. Other areas, however, such as the very small-scale recording and processing of accidents at work and commuting accidents, would be eliminated. In addition, the costs of providing services would fall. This is because the employers' liability insurance associations now provide significantly higher benefits than the health insurance funds. It is difficult to explain why an injured person receives better benefits if they suffer this injury at work and not, for example, at home. A significant proportion of the total expenditure in the accident insurance system - at least a mid-single-digit billion amount - could therefore be saved by abolishing accident insurance.
More important than the monetary effects for many companies, however, may be the elimination of the bureaucracy associated with membership of the employers' liability insurance associations. This is disproportionately time-consuming, especially for small companies. It is also a relief for injured persons not to have to think about whether they can go straight to the nearest doctor or whether they first need to see a transit doctor with the right license.
Liability for accidents at work and occupational illnesses
The crux of the reform would be the clarification of liability issues for companies in the event of accidents at work and occupational illnesses. Here, the legislator would first have to clearly define cases of liability by law, so that civil liability only arises in cases of clear negligence on the part of the employer, which would result in a claim for damages. However, treatment costs - even for long-term cases - would in any case be borne by the relevant health insurance company. Since the employer pays half of their contribution anyway, it would be nonsensical to claim that it would be antisocial to have illnesses caused by employers covered by general health insurance.
If this liability risk is covered, the amount of damage to be insured via corporate liability would not change significantly compared to today's liability. This is because it already has to cover compensation for negligence.
After all, the employers' liability insurance associations and accident insurance funds are responsible for health care and accident prevention measures. This system can therefore only be successfully abolished if the many safety, monitoring, instruction and notification obligations, which today often lead to absurd sham training in companies, are reduced to what is necessary according to common sense. Companies and their employees should be trusted with a fundamental sense of responsibility. The mandatory prevention and safety measures remaining after a reform should be monitored by the existing trade supervisory authority. This would also eliminate a duplicate structure in this area.
The reform outlined here should not stand alone. It must fit into an overall approach of state modernization that leads to a more effective, transparent and efficient provision of state services through the reform of several instruments.
1 https://www.bmas.de/DE/Service/Statistiken-Open-Data/Statistiken-der-gesetzlichen-Unfallversicherung/berichtsjahr-2022.html. Newer data not available
