The German Long-Term Care Insurance Program: Evolution and Recent Developments

Nadash, Pamela; Doty, Pamela; Schwanenflügel, Matthias von

doi:10.1093/geront/gnx018

Cited by 72 publications

(77 citation statements)

References 14 publications

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“…Long-term care (LTC) policies for older people have followed heterogeneous paths across Europe during the recent period of economic austerity (Greve 2017 a ). In some countries, most notably Germany (Nadash, Doty and von Schwanenflugel 2017), major changes have been introduced to improve the system and increase public funding, while in others, such as Sweden (Greve 2017 b ) and Finland (Waldhausen 2014), the policies already in place have not been substantially modified by the change in the economic climate. In several countries, since the second half of the 2000s and in particular since 2010, cost-containment policies have been applied to LTC.…”

Section: Introductionmentioning

confidence: 99%

Changing long-term care provision at the local level in times of austerity – a qualitative study

Gori

2018

Ageing and Society

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In the first decade of the century, long-term care (LTC) policies for dependent older people in Italy were improved with respect to both the availability of public funds and the quality of services. At the turn of the decade, however, cost-containment and austerity measures were imposed as an overall priority for the public sector and this goal also affected the LTC sector. This article explores the effects produced by cost-containment policies, which widened the gap between care needs and available public funding, on the provision of LTC services at the local level in Italy during the economic crisis. The study is based on 34 semi-structured interviews with services managers employed in Italy's publicly funded LTC system. Data were analysed with the framework analysis method and six cross-cutting thematic categories were identified that depict, according to the interviewees, the main transformations that occurred in the provision of LTC at the local level as a consequence of cost-containment policies. ‘Uncertainty’ refers to the inability to predict what direction the LTC system is going to take in the foreseeable future. ‘Short-termism’ illustrates the pressure to focus excessively on day-to-day service delivery at the expense of a medium- to long-term view of their future. ‘Endangering quality’ describes the risk of not being able to maintain the level of quality of care achieved so far. ‘Allocative tensions’ refers to the tensions due to the increasing requirement to ration the provision of public LTC services. ‘Unequal re-familiarisation’ represents the very different impacts of the trend of re-familiarisation depending on families’ financial situation. ‘Inappropriate care’ depicts the rising number of older people receiving public care interventions that are not appropriate to meet their needs.

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Section: Introductionmentioning

confidence: 99%

Changing long-term care provision at the local level in times of austerity – a qualitative study

Gori

2018

Ageing and Society

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“…Since 1995, Germany has been implementing a public program that provides universal support for the costs of long-term services and support (LTSS) [7]. The most significant feature of the German LTCI program is its universal coverage.…”

Section: Ltci In China and Other Countriesmentioning

confidence: 99%

Prediction of the Number of and Care Costs for Disabled Elderly from 2020 to 2050: A Comparison between Urban and Rural Areas in China

Zhang

Fang

2020

Sustainability

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An aging population and an increase in the proportion of elderly people who are disabled have created an unprecedented global challenge, especially in China. This study aimed to predict the number of, and the care costs for, disabled elderly from 2020 to 2050 in China. A comparison was made between urban and rural areas, and we analyzed what must be done to maintain the sustainable development of China’s long-term care insurance (LTCI) system. An overall simulation model and a Monte Carlo simulation were used to estimate the number of disabled elderly and their related care costs, in both urban and rural areas. According to the forecast, the total disabled population will increase rapidly, rising from 43.75 million in 2020 to 91.4 million in 2050. Of that total, 69.7% are expected to be urban elderly. Starting in 2020, the growth rates of the elderly with mild, moderate, and severe disabilities will be 108%, 104%, and 120%, respectively, by 2050. Accordingly, the total care costs will increase from 538.0 billion yuan in 2020 to 8530.8 billion yuan in 2050, of which 80.2% will be required in urban areas. In addition, the per capita costs of care in urban and rural areas in 2050 will be 6 times and 11 times higher than in 2020, respectively. The predicted results show that the number of disabled elderly and the related care costs will increase sharply from 2020 to 2050, especially the growth rate of the number of severely disabled elderly. This study provides strong evidence of the need for the establishment of a unified national LTCI system in China.

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“…The "why" question concerns policy legacy, cultural norms, institutional frame, social and economic context, role of political and social actors, broad political context and so on. A glance at both the various national trajectories in LTC financing occurred since the nineties across OECD -mentioned above -and the different reactions to recent times of austerity [16][17][18] highlights the importance of the political variable. In brief: an extensive knowledge on how to collect public resources should be matched by an equally extensive understanding of the reasons why politicians aim (or not) to devote more resources to LTC.…”

Section: Politics Of Long-term Carementioning

confidence: 99%

Long-term Care Financing: Inserting Politics and Resource Allocation in the Debate Comment on "Financing Long-term Care: Lessons From Japan"

Gori

2019

Int J Health Policy Manag

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The ageing of the countries’ populations, and in particular the growing number of the very old, is increasing the need for long-term care (LTC). Not surprisingly, therefore, the financing of LTC systems has become a crucial topic across the Organisation for Economic Co-operation and Development (OECD). In the last three decades, various financing policies have been carried out in different countries and the related international debate has grown. The latter has so far focused mostly on the different alternatives to collect economic resources to pay for care. The international debate needs now to focus also on other issues, so far less discussed. One is the politics of LTC: the degree and nature of the political interest in LTC, that affects the size and profile of public financing. The other is resource allocation: how different services and benefits are distributed among people with different care needs, that determines if resources made available are optimized. If we do not pay more attention to these issues – inextricably connected to policies aimed to collect funds – our understanding of LTC financing will remain inevitably limited.

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The German Long-Term Care Insurance Program: Evolution and Recent Developments

Abstract: The reforms constitute a significant strengthening of the program, remarkable in an era of retrenchment. Overall, the program provides evidence for the financial viability of a social insurance model, although longer-term challenges may yet arise.

Cited by 72 publications

References 14 publications

Changing long-term care provision at the local level in times of austerity – a qualitative study

Changing long-term care provision at the local level in times of austerity – a qualitative study

Prediction of the Number of and Care Costs for Disabled Elderly from 2020 to 2050: A Comparison between Urban and Rural Areas in China

Long-term Care Financing: Inserting Politics and Resource Allocation in the Debate Comment on "Financing Long-term Care: Lessons From Japan"

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