The German Social Long-Term Care Insurance - Structure and Reform Options
29 Pages Posted: 14 Nov 2006
Date Written: March 2007
In Germany, long-term care is an important issue due to an aging population and shrinking social networks that result in a greater need for a public long-term care system. In 1995, the social long-term care insurance was introduced in Germany. Long-term care insurance funds are generally linked to health insurance funds. The benefits are financed by virtue of an income-based system where all employees covered by the social security system and their employers have to pay equal contributions on a pay-as-you-go basis. In case of long-term care needs a frail person is assigned to one of three care levels according to his/her severity of need.
In recent years, there is a growing need of reforming the long-term care insurance: While health insurance is a fully comprehensive system, long-term care insurance only provides limited coverage. Additionally, there is a lack of competition on the long-term care market. Finally, the financial situation of the German social long-term care insurance is tight. While in the first years after introduction the net results of revenues and expenditures were positive they have been negative since 1999 which is due to an increasing number of benefit recipients. Therefore, we discuss several reform options which have been proposed in order to overcome financial and structural problems. Suggestions for the income side include the introduction of fixed premiums, a fully funded system, a private insurance, or a citizens' insurance. The main problem here is to finance the transition from one system to another. We discuss recent proposals for the transition to a sustainable long-term care insurance in Germany.
Keywords: social insurance, long-term care, social system
JEL Classification: I10, I12, I18
Suggested Citation: Suggested Citation