Nursing care insurance reform announced for this legislature

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Written By Kampretz Bianca

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Berlin – Federal Health Minister Karl Lauterbach (SPD) today announced a major reform of nursing care that the traffic light coalition intends to pass during this legislative period.

“We will present a concept after the summer break,” Lauterbach said in Berlin after the Federal Cabinet approved the report “Future-proof financing of social long-term care insurance” by an inter-ministerial working group on the future financing of long-term care insurance.

Four possible financing options are suggested: two as part of partial insurance and two as full insurance options. The coalition factions announced the presentation of this report in their coalition agreement. However, the model was originally planned for last year.

Expenditure on statutory nursing care insurance has recently increased sharply. As Gernot Kiefer, former vice-president of the National Association of Statutory Health Insurance Funds, recently explained, a deficit in long-term care insurance of 650 million euros had accumulated in the first quarter of 2024 alone. A loss of 1.5 billion euros is expected for the whole year, Kiefer said, and a deficit of 3.4 billion euros in 2025.

Avoid nursing cases through prevention

The working group’s report shows the expected increase in expenditure on partial insurance in the long term. “Due to demographics and depending on global economic development, in the partial benefit system with value preservation dynamics for people in need of care, a financing gap of 0.5 to 2.6 contribution rate points, on average 1.4 contribution rate points, will arise in the long term,” it says. The average value corresponds to around 24 billion euros at “today’s prices”.

Lauterbach explained that the problem of financing long-term care insurance can be solved: “It’s not a cost explosion that we’re facing.” “The most important thing that is underestimated here is the prevention of nursing cases,” Lauterbach said.

“We have so many preventable strokes, so many preventable cases of severe heart failure, so many preventable cases of dementia that we can actually limit the need for care if we do more to prevent it. The Good Heart Act will have a corresponding effect. to prevent it.”

Nursing funding reform must be accompanied by new laws that, among other things, should lead to more nursing staff in the health system: such as the Nursing Care Act and the Nursing Skills Act.

The government will therefore present a comprehensive care concept that, in addition to funding, will also improve the provision of care and ensure the empowerment of family caregivers. However, it does not want to speculate yet on the details of the reform.

A smorgasbord of renovation options

Before the minister’s announcements, health associations and insurers had already stressed the importance of reforming the financing of long-term care insurance in this legislative period. They criticized the working group’s report. It contains “few new ideas and is at best a hodgepodge of reform options and eventualities,” said Anne Kathrin Klemm, board member of the umbrella organization BKK.

The CEO of Techniker Krankenkasse, Jens Baas, explained: “The federal government’s report on the financing of nursing care simply sums up the known problems. Concrete measures are needed.” The long-awaited health care reform must not be postponed again until the next legislative period.

He demanded that the federal government relieve nursing care funds of non-insurance benefits and expenses in times of pandemic. “This does not require further problem analysis, but rather legislative initiatives,” Baas emphasized.

Take care of bankruptcies

The president of the Catholic Association for Elderly Care in Germany (VKAD), Barbara Dietrich-Schleicher, also called on the federal government to take action to address the funding shortfall for nursing care: “If the funds are soon no longer able to pay on time, insolvencies in nursing facilities will increase. The need for nursing care is enormous – and the trend is set to increase. Politicians must act decisively to ensure that more providers do not fall into financial difficulties and that the necessary supply capacities are reduced.”

“In addition to a fundamental reform of the financing of long-term care insurance that goes beyond the legislature, immediate action must be taken,” demanded Dietrich-Schleicher, citing the example of those in need of outpatient care.

“More and more people who are cared for at home are giving up care services. If someone gives up personal care because it has become too expensive, then something is wrong. Long-term care insurance must be designed in such a way that the gap between rising prices and in-kind care benefits – including personal care, nursing or housework – is closed.

The report is preceded by an inventory of the status quo. Thus, a large proportion of the approximately 5.2 million people in need of care are currently cared for on an outpatient basis. Last year, this was around 84%. Here, it is usually family members who provide care and receive a care allowance in return. Around 700,000 people are in full-time hospitals and around 140,000 are in inpatient care facilities.

According to the report, total expenditure on social insurance for long-term care was around €59.2 billion in 2023. Of this, €36.2 billion was attributable to outpatient services and €19.7 billion to inpatient services. Although only 13 percent of people in need of care are treated in full inpatient settings, one third of total expenditure is incurred in this area.

The first of the four financing options proposed by the Commission describes a continuation of the status quo: i.e. an interplay of insured contributions, taxpayers’ money and private contributions. Alternatively, the authors suggest a further development of the current system in which the private contribution is reduced and a new mandatory individual provision is also introduced.

Two other proposals describe a comprehensive pay-as-you-go insurance, which is financed through contributions and taxes or solely through a pay-as-you-go system. © fos/aerzteblatt.de

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