Discount with Side Effects: Why Special Agreements in Healthcare Are Becoming a Risk

Christian Linz, state managing director of the Bavarian Taxi- and Hire-Car Association, describes in a current information sheet the legal foundations – and above all the practical consequences. His analysis reads like an inventory of a system that has clearly fallen out of balance.

Duty to provide care — and to contractual binding

Starting point is § 133 SGB V. According to this, health insurance funds are obliged to ensure nationwide provision of patient transports for their insured. This goal is clearly defined: services should be available, economical and plannable. At the same time, the in-kind benefits principle of the statutory health insurance applies. The patient receives the prescribed service directly, the insurer covers the costs.

Taxi- and rental-car companies play an important role here – especially when public transportation is not an option. The legislator provides that health insurers shall enter into corresponding remuneration agreements with suitable companies, unless they are already regulated by tariff regulations.

Tight guardrails for special agreements

Special agreements cannot be freely designed in the mandatory taxi sector. Section 51(2) PBefG sets clear conditions: Defined timeframes or minimum quantities are required; the transport market must not be disturbed; prices and terms must be fixed in writing. In addition, licensing or notification obligations apply, which arise from the respective municipal taxi regulations.

In practice, however, the picture is inconsistent. While many municipalities require approvals, some rely solely on a notification obligation. From the association's point of view, this weakens control and opens up room for maneuver that can be economically problematic.

When discounts become part of the system

The core of the criticism lies in the economic impact of these agreements. According to the association's observations, the agreed prices are often 10 to 15 percent below the regular taxi tariff. If one adds missing waiting-time compensations, the shortfall amounts to around 20 percent.

This difference does not come without consequences. Companies come under pressure; profitability declines. In many cases, businesses respond with applications for tariff increases in the regular taxi traffic. The consequence is an indirect offset: The typical passenger subsidizes the discounts in patient transport through higher tariffs. A cycle arises that is neither market-appropriate nor legally intended.

Chain reactions among the payers

In addition, another effect on the demand side. When companies grant price concessions to individual health insurers, it raises expectations among other payers. A tangle of different agreements is created—a patchwork that is hardly easy to oversee.

For the approving authorities, monitoring becomes more difficult. At the same time, a creeping loss of tariff autonomy looms. Because the more prices are negotiated outside the official tariff framework, their practical significance diminishes.