Pressure for major financial reform for post-election care | free press

Berlin (dpa) – More and more people in aging Germany need care – but how is that paid?

In view of the ever-increasing out-of-pocket payments for people in need of care and their families, a fundamental reform of health care financing is an important social issue in the Bundestag elections.

Proposals have been on the table for a long time: from more tax billions over lids for personal contributions to a complete conversion of the model. The current grand coalition has already sealed the last few meters of emergency aid and demands for better pay for aged care workers. Consumer and patient advocates are pushing for more.

“Clear capping” needed

The head of the Federation of German Consumer Organizations (VZBV), Klaus Müller, told the German News Agency that costs had risen so exorbitantly that for many people they were unbearable and that they were practically the safest route to social security. At the same time, non-wage labor costs could not continue to rise. “That’s why we need an increasing share of tax revenue.” With the rising co-payments for home care, “a very clear ceiling” is needed, with long-term care insurance taking a larger share.

The board of directors of the German Foundation for Patient Protection, Eugen Brysch, told the dpa: “Especially when fair wages are required, the real costs reverberate for those affected. Victims of this fatal mechanism are people being cared for at home as well as nursing home residents.” Long-term care insurance policies must finally be generational, future-proof and funded.

Significant regional differences

Shares payable for home residents have been rising for years and now stand at 2,125 euros per month in the national average. That is 57 euros more than at the beginning of the year and 110 euros more than in mid-2020, according to data from the Association of Replacement Health Insurance Funds as of 1 July. On the one hand, this includes the deductible for pure care. Because unlike health insurance, long-term care insurance only bears part of the cost. In addition, there are often rising costs for housing, meals and also for investments in facilities. And there are major regional differences.

Health Minister Jens Spahn (CDU) has already responded with a reform. From January 1, 2022, there will be a new price. The personal share for pure care should fall by 5 percent in the first year at home, by 25 percent in the second year, by 45 percent in the third year and by 70 percent from the fourth year. At the same time, from September 2022, there may only be supply contracts with homes that pay according to the rate or similar. To finance this, the healthcare contribution for childless people will increase from 3.3 to 3.4 percent. From 2022, the federal government will also donate a billion euros annually as a gift to long-term care insurance.

Subsidy principle

Müller spoke with a view to exonerating a “bad offense”. The government has suspended an animation of care for the coming years. “That means that the dependents themselves have financed the improvements for the right pocket from their left pocket.” Brysch said long-term care insurance was “not even partially comprehensive insurance,” based on the subsidy principle. Only the government decides on subsidies adjustments – but this should be determined by the development of expenditure. “This is not full funding. Because the person in need of care pays for housing, meals and above-average comfort.”

At the end of last year, a total of 4.3 million people were receiving benefits from statutory long-term care insurance – just under four million at the end of 2019. In some of the election manifestos, the parties are promising far-reaching financial reforms.

Parties offer different approaches

“We want full insurance as a citizen insurance that covers all nursing needs and services,” explains the SPD. A first step in this direction is capping the personal contribution for people in need of care with low and middle incomes. Future cost increases should be funded by a mix of “moderately increasing” health care contributions and a “dynamic federal grant.”

The Greens want to reduce their own shares and cap it with a “double care guarantee”. Long-term care insurance must then cover all additional costs for outpatient and inpatient care. “With solidarity-based long-term care social insurance, we want to ensure that everyone with means-tested contributions contributes to the financing of health care risk,” the program said.

The union wants to investigate “how we can strengthen and promote the instrument of company supplementary long-term care insurance to the state”. In order to counter the disproportionately rising premiums given the demographic change, the long-term care provision fund should be extended until 2050. According to the Ministry of Health, it should contribute to stabilizing the premium rate from 2035.

The FDP wants to maintain long-term care insurance as a “partial service” and — as with retirement — supplement it with private and occupational retirement plans. “In particular, the development of business models for complementary care needs to be supported.” Die Linke wants full insurance that covers all healthcare services; own contributions should be omitted. “We want to transfer non-profit healthcare companies to common ownership.” The AfD proposes a merger of long-term care and statutory health insurance. “The size of social insurance benefits for long-term care needs to be aligned with the insurance principle in health insurance.”

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