Can social insurance for long-term care work? The experience of Germany

Health Affairs

Volumn 19, Issue 3, 2000, Pages 8-25

  Cuellar, Alison Evans ^a   Wiener, Joshua M ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CASE MANAGEMENT; ECONOMICS; FINANCIAL MANAGEMENT; GERMANY; HEALTH CARE DELIVERY; HEALTH CARE QUALITY; HEALTH INSURANCE; INSURANCE; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT;

CASE MANAGEMENT; ELIGIBILITY DETERMINATION; FINANCING, GOVERNMENT; GERMANY; HEALTH SERVICES ACCESSIBILITY; INSURANCE, LONG-TERM CARE; QUALITY OF HEALTH CARE; UNIVERSAL COVERAGE;

EID: 0034185139     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.3.8     Document Type: Article

References (46)

1. German Parliament, 13th Voting Period, First Report on Developments in the Long-Term CarelnsuranceProgram, vol. 13/9528 (Bonn: 19 December 1997), 8-9 (in German).
2. This section refers to the historical situation in West rather than East Germany.
3. J. Alber, "The Debate about Long-Term Care Reform in Germany," in Caring for Frail Elderly People: Policies in Evolution, ed. P. Hennessy (Paris: Organization for Economic Cooperation and Development, 1996), 261-278; U. Goetting et al., "The Long Road to Long-Term Care Insurance in Germany," Journal of Public Policy 14, no. 3 (1994): 285-309; and U.S. General Accounting Office, Long-Term Care: Other Countries Tighten Budgets while Seeking Better Access, Pub. no. GAO/ HEHS-94-154 (Washington: GAO, 1994).
4. J. Alber, "The Debate about Long-Term Care Reform in Germany," in Caring for Frail Elderly People: Policies in Evolution, ed. P. Hennessy (Paris: Organization for Economic Cooperation and Development, 1996), 261-278; U. Goetting et al., "The Long Road to Long-Term Care Insurance in Germany," Journal of Public Policy 14, no. 3 (1994): 285-309; and U.S. General Accounting Office, Long-Term Care: Other Countries Tighten Budgets while Seeking Better Access, Pub. no. GAO/ HEHS-94-154 (Washington: GAO, 1994).
5. J. Alber, "The Debate about Long-Term Care Reform in Germany," in Caring for Frail Elderly People: Policies in Evolution, ed. P. Hennessy (Paris: Organization for Economic Cooperation and Development, 1996), 261-278; U. Goetting et al., "The Long Road to Long-Term Care Insurance in Germany," Journal of Public Policy 14, no. 3 (1994): 285-309; and U.S. General Accounting Office, Long-Term Care: Other Countries Tighten Budgets while Seeking Better Access, Pub. no. GAO/ HEHS-94-154 (Washington: GAO, 1994).
6. Kuratorium Deutsche Altershilfe, Review of Institutional Care of Sickness in Old Age and the Assumption of Costs by the Sickness Funds (Cologne: KDA, 1974) (in German).
7. Higher-income Germans can opt to buy private insurance if they have incomes over DM 6,375 ($3,188) per month, but it is difficult for individuals to return to the sickness funds once they have left.
8. However, Länder receive the equivalent of a federal "general revenue sharing block grants," which provide much of their funding and reduce revenue differences across geographic areas.
9. Report of the Ministry for Labor and Social Affairs to Parliament (Bonn: Ministry for Labor and Social Affairs, 7 March 1997) (in German).
10. Ibid.
11. High-income persons who opt out of sickness funds for acute care must receive long-term care through their private insurers. Their monthly premium may not exceed 1.7 percent of the opt-out income threshold. In 1998, of the 8.5 million privately insured, 89,000 were receiving long-term care benefits, compared with 1.8 million out of 71.4 million persons insured through sickness funds (www.bmgesundheit.de/pflege/zahlen/aus.htm, March 1999).
12. Paid holidays are mandatory for most businesses in Germany. One of the Länder, Sachsen, voted not to eliminate a holiday and to have workers pay the entire premium.
13. In Germany contributions are mandatory only for persons below set income thresholds. Persons above these thresholds can purchase alternative private insurance and are not subject to the tax.
14. "Social Expenditures Increase Despite Contribution Reductions," Süddeutsche Zeitung, 4 March 1999 (in German).
15. All dollar estimates are based on 1998 purchasing power parities from the Organization for Economic Cooperation and Development, Main Economic Indicators (Paris: OECD, January 1999).
16. German Ministry of Health, unpublished data; and German Parliament, 13th Voting Period, First Report on Developments.
17. German Ministry of Health, unpublished data.
18. German Parliament, 13th Voting Period, First Report on Developments.
19. "Die Finanzentwicklung der sozialen Pflegeversicherung," www. bmgesundheit.de/themen/pflege/zahlen/tabs/ent.html (27 March 2000).
20. German Ministry of Health, unpublished data.
21. ADLs include personal hygiene (bathing, using the toilet, shaving, brushing teeth), eating (including food preparation), and mobility (transferring in and out of bed, dressing, walking, standing, climbing stairs, leaving and returning home). IADLs are household activities (shopping, cooking, cleaning, washing clothes, washing dishes, heating the home).
22. The medical office is allowed to designate certain persons already at Level III to be "hardship" cases, if they need at least two simultaneous caregivers at night or if they need at least seven hours of ADL assistance per day with at least two hours occurring at night. See German Parliament, 13th Voting Period, First Report on Developments.
23. Ministry for Labor and Social Affairs, "Social Long-Term Care Insurance," Bundesarbeitsblatt (March 1999): 127 (in German).
24. Medical Office of the Association of Sickness Funds, unpublished data.
25. J. Wilbers, "Long-Term Care in Germany" (Unpublished paper, Trier, Germany, 1998) (in German).
26. Ibid.
27. Ministry for Labor and Social Affairs, Germany's Way into the Twenty-first Century: Excerpts from the Coalition Agreement, Stabilizing Long-Term Care (Bonn: Ministry for Labor and Social Affairs, 1999) (in German).
28. German Parliament, memorandum 14/1203 (22 June 1999).
29. Ministry for Labor and Social Affairs (March 1999).
30. Report of the Ministry for Labor and Social Affairs to Parliament.
31. Ibid.
32. Kuratorium Deutsche Altershilfe, Pilot Study on Partial Day Care in Nordrhein-Westphalen (Cologne: KDA, 1997) (in German).
33. Ministry for Labor and Social Affairs, First Report of the Ministry for Labor and Social Affairs to Parliament in Accordance with S. 10 subpara. 4, Sozialgesetzbuch XI (Bonn: Ministry for Labor and Social Affairs, 12 September 1997); and J. Forster, "Sharper Controls in Nursing Homes," Süddeutsche Zeitung, 10 March 1999 (in German).
34. Ministry for Labor and Social Affairs, First Report of the Ministry for Labor and Social Affairs to Parliament in Accordance with S. 10 subpara. 4, Sozialgesetzbuch XI (Bonn: Ministry for Labor and Social Affairs, 12 September 1997); and J. Forster, "Sharper Controls in Nursing Homes," Süddeutsche Zeitung, 10 March 1999 (in German).
35. J. Wilbers, "Long-Term Care in Germany."
36. M. Aberle, "One Toothbrushing, 3.30DM," Frankfurter Allgemeine, 10 November 1998.
37. Ministry for Labor and Social Affairs, First Report; and Forster, "Sharper Controls in Nursing Homes."
38. Ministry for Labor and Social Affairs, First Report; and Forster, "Sharper Controls in Nursing Homes."
39. G. Niehoerster et al., Identifying the Potential for Independent Living, vol. 147.4 (Bonn: Ministry for Family, Seniors, Women, and Youth, 1998).
40. P. Pick, "Quality and Quality Assurance in Long-Term Care," Die Ersatzkasse (October 1998): 465-467.
41. D. Mittler, "Caritas Takes On the Sickness Funds," Süddeutsche Zeitung, 8 April 1999 (in German).
42. Wilbers, "Long-Term Care in Germany."
43. Medical Office of the Association of Sickness Funds, "MDK-Concept Paper on Quality Assurance in Long-Term Care according to SGB XI" (Essen: MDK, October 1998) (in German).
44. Pick, "Quality and Quality Assurance in Long-Term Care."
45. German Parliament, 13th Voting Period, First Report on Developments.
46. G. Anderson, Health and Population Aging: A Multinational Comparison (New York: Commonwealth Fund, October 1999).