The emerging market for supplemental long term care insurance in Germany in the context of the 2013 Pflege-Bahr reform (original) (raw)
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The introduction in 1996 of free choice among sickness funds in Germany was accompanied by a "risk structure compensation" (RSC) mechanism based on average spending by age and sex. Because chronically ill people were not adequately taken into account, competition for newly insured consumers concentrated on the healthy. The introduction in 2002 of disease management programs addresses this problem: Insured people in such programs are treated as a separate RSC category, making them a more "attractive" group that no longer generates a deficit. The degree of sickness fund activities and the fierce dispute with physicians are valid indicators that the incentives work.
Long-term Care Insurance in Germany Assessments, benefits, care arrangements and funding
The establishment of Long-term Care Insurance (LTCI) in Germany in 1995/96 significantly restructured Germany's public long-term care support. Before, the responsibility for providing care to Germany's elderly population lay mainly with the family, while based on the principle of subsidiarity public support was only available after a means-test within a tax-based social assistance framework. The law on LTCI established a social-insurance and mandatory private insurance scheme to grant universal public support in strictly defined situations of care dependency. LTCI in Germany was created at the beginning of the 1990s in a situation of welfare state constraints characterised by criticism towards comprehensive public welfare spending and an increasing emphasis on individual responsibilities and market solutions (Landenberger, 1994; Meyer, 1996). Against this background the law was a compromise on the balance of private, family, public and market responsibilities between more ec...
Lessons From Public Long-Term Care Insurance In Germany And Japan
Health Affairs, 2010
The U.S. Congress is considering the Community Living Assistance Services and Supports (CLASS) Act, a voluntary insurance program that would help pay for long-term services and supports to disabled Americans. In Germany and Japan, social insurance programs are universal, support family caregivers, and allow individuals considerable flexibility in securing the services they require. We explored differences between Germany and Japan in program goals, eligibility process, scope, size, and sustainability for possible applications in the United States. Moreover, when we compared public spending on longterm care, we found that spending in the United States is actually higher than in Germany even now, prior to enactment of the CLASS Act, and is only slightly lower than in Japan. T wenty years ago, policy for care of frail older people in Germany and Japan was much like it is in the United States today. Programs financed mostly from tax revenues provided means-tested access to nursing homes and, in some areas, to a few community-based services such as home help. Today, Germany and Japan have universal, comprehensive long-term care systems based on social insurance. A variation on this model is now under consideration in the U.S. Congress, in the form of the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary insurance program that would help pay for long-term services and supports to some disabled Americans. In this article we argue that an even broader program of universal long-term care insurance is a practical and affordable solution to problems of coverage and fairness, and we describe differences between the German and Japanese programs that illustrate some important policy choices. Public Long-Term Care Spending Compared We start with a look at what Germany, Japan, and the United States spend on long-term care. Cross-national data compilations that allow separation of spending on the elderly are not available, so we compiled basic data on long-term care spending using best available data from 2005, the latest year with complete data for Germany and Japan. 1-6 We adjusted these data to exclude spending for people under age sixty-five in the United States and Germany, by referring to unpublished data or estimating on the basis of the best information available. (In Japan the official data are broken down by age.) 7,8 We did our best to define consistent categories across the three countries, again estimating in a few cases. For example, there are no official data on long-term care provided in hospitals and paid by health insurance in Japan. In some instances, we consulted the officials or experts who had compiled the data we used to ensure that our estimates were reasonable. To maintain comparability among the countries, we excluded most Medicare postacute spending, because it would be regarded as med
Pooling public and private funds in the patient's interest: The case for long-term care insurance
Social Science & Medicine, 1996
A~tract-Although the extent of medical care in France may be thought adequate, the same does not apply to the social medicine sector. The Assurance-maladie paid 87.7% of hospital health expenditure in 1994, whereas direct funding of home assistance amounted to only 9%. In contrast, a recent Legos study (Bungener M. et al. Le bilan 6conomique et financier du secteur mbdico social, Universit6 de Paris IX, Legos, Janvier 1994) [1] estimated that home assistance costs represent 41-50% of medical social expenditure. When people are unable to manage because of the high costs of their invalidity, the social security system comes to their assistance, although only under Draconian conditions involving compulsory "family support commitments" and the state's claim on the inheritance of the beneficiary (total costs for hospital admission and boarding and the dual limits of 1000F liabilities and 250,000F net assets for home assistance). The elderly well appreciate the severity of this problem and are deeply distressed by the thought of dependency. Many, however, live under the illusion that the social security system or, to a lesser extent, the mutual funds will come to their assistance, although the problems involved lie partly outside their remits. We therefore need to design new systems to allow the elderly to finance their costs should they become dependant.
The Long Road to Long-Term Care Insurance in Germany
Journal of Public Policy, 1994
ABSTRACTThis paper represents a case study in welfare state expansion. It takes an actor-centered point of view and reconstructs the long process which has ultimately led to a compromise solution to the problem of providing long-term care, especially for the elderly. It describes the previously means-tested arrangement of long-term care provision and its shortcomings. Furthermore, it sketches the different stages through which the political debate on this issue has passed during the last twenty years: from the initial phase of defining the “social problem”, to the final stage when the approval of the compromise package became a question of “all or nothing”. The analysis of the politics of long-term care insurance reveals that the difficulties of reaching an agreement mainly resulted from the complex decision-making situation. It was in essence a problem of decision-making under conditions of general uncertainty.
The Social Long-term Care Insurance: A Frail Pillar of the German Social Insurance System
CESifo DICE Report, 2010
in Magdeburg and ZEW Mannheim, Germany. 1 This number also includes eastern Germany. For a more detailed description on the history of social long-term care insurance in Germany, see Heinicke and Thomsen (2010). 2 As emphasized by Götting, Haug and Hinrichs (1994), the shrinking supply of informal caregivers and concerns about the supply and quality of professional care in light of an increasing demand also fueled this debate. 3 Before the introduction of the social long-term care insurance, the German social insurance system was comprised of four pillars: unemployment insurance, health insurance, pension insurance, and accident insurance. They all follow the principles of solidarity, selfadministration and funding by social insurance contributions.
Personal responsibility for health--developments under the German Healthcare Reform 2007.
European Journal of Health Law
Appeals to personal responsibility for health are controversial in many countries, especially in those that have publicly funded healthcare systems. In Germany, personal responsibility has traditionally been a focal point in the statutory health-insurance scheme. The most recent healthcare reform under the motto 'prevention before treatment, rehabilitation, and long-term care' came into force on 1 April 2007 through the Gesetz zur Stärkung des Wettbewerbs in der gesetzlichen Krankenversicherung (GKV-WSG--"Law to strengthen competition among providers of statutory health-insurance scheme"). In significant parts, the law has given further emphasis to the role of personal responsibility. Implications of three important changes are discussed: (1) insured persons may no longer claim free treatment for complications arising from certain 'lifestyle choices'; (2) chronically ill and cancer patients face more stringent compliance requirements or face higher co-payments; and (3) insured persons may cash 'no-claim bonuses' if over at least one year they do not require hospitalisation or prescription medicines. Previous emphasis on personal responsibility has had relatively broad support in Germany. The long-term acceptability of the new measures will depend on several factors, including the structural and financial impact on different providers of statutory health insurance, and the capacities and opportunities of different groups in society to make use of the new provisions.