How to help care? – IMIESA

If the most important issues are raised in coalition negotiations, one thing will certainly not be missing: the next healthcare reform. As is known, there is a broad consensus that the current nursing crisis, which is becoming more and more threatening with demographic changes, must be eliminated and that this can only be achieved through better working conditions. attractive. At the same time, however, it’s also important to keep runaway costs under control. You may have to put the whole system on a whole new basis for this. Even conservatives, like Bavarian Minister of Health Klaus Holetschek (CSU), are already using the pithy word “revolution” for what is to come. However, what the necessary reform of financing should look like and how far to go, opinions are quite opposite. like retirement and health. But it gets exciting in the details. How much and how reliably should the explosive costs to the residents of the home be capped if you don’t want to let them fall back into welfare as before? What exactly should the accompanying tax financing look like, should it be based on needs and the cash flow situation or according to well-defined criteria? And: How can a better balance be found between members of social long-term care insurance (SPV) and those of private long-term care insurance (PPV) who currently pay less for identical services when they have a much higher income?

A capped personal contribution or just a subsidy?

Klaus Jacobs and Dietmar Haun of the Scientific Institute looked at these questions dedicated to AOK (WIdO) in a long analysis. It also contains the current calculations – for the various structures insured in SPV and PPV as well as for the explosive increase in the share of residents in EHPAD. According to information, the latter will be in just three and a half years between the fall of 2017 and the second quarter of 2021, about 25% increase. The average charge on the national average is now 2.185 euros per month. And by far, most of this increase is due to direct care and training costs: these so-called Unit Level Own Contributions (EEE) have even increased by an average of 53.7 percent. This proves the size and dynamics of the problem quite impressively.

Because this can hardly last, two relief models are to be debated: a fixed maximum amount for the people concerned or proportional subsidies according to a certain distribution key. The first would correspond to the initial proposal for “care coverage” by Minister of Health Jens Spahn, according to which people in need of care would not exceed 700 euros per month for up to three years of home care should themselves. to pay. The latter would follow the regulation recently passed by law, according to which – as a cheaper solution – only a percentage subsidy to the EEA is provided, from 2022 depending on the length of stay in the home in annual graduation 5, 20, 45 and 70 percent should be.

“It would be desirable if the policy was clear in deciding the model to which it basically aspires,” the authors write. And in doing so – if the care policy is to be more “than just messing around” – the respective consequences must be taken into account. So, as Bremen nursing scientist Heinz Rothgang calculated, the approved subsidy regulations would only give the affected person relief for two years without further adjustment. On the other hand, with fixed coverage, long-term care insurance alone would bear the risk of a further increase in costs; the amount of the user fee could be provided for all residents of the home. Regarding the inevitable co-financing of taxes, Spahn is already committed to the Law for the Further Development of Health Care (GVWG). It stipulates that the social dependency insurance will receive one billion euros per year from the federal government in 2022. But contrary to the key points of the Minister, where the financing of tasks for society as a whole was argued, the law is lacking henceforth any substantial justification for this tax subsidy. The authors of WIdO consider this to be “extremely problematic”. As a result, the federal grant, they write, is “on fragile feet.” In any case, a “cash grant” could “hardly be considered a useful instrument for the sustainable financing of the SPV”. Instead, the tasks of society as a whole, which justify injections of funds from the fiscal pot, must be clearly defined.

In addition, the Länder must now finally be required to make a reliable and “significant contribution to the promotion of investment costs”. As before, they would not fulfill their responsibility “to maintain an efficient, numerically sufficient and economical nursing structure” (Article 9, SGB XI). A huge burden for the residents of the retirement home: according to WIdO’s calculations, this alone gave them an additional 443 euros per month. In the cornerstones of Spahn, a compulsory Länder subsidy of 39 euros per month was provided for each full hospitalization, in the adopted law it is absent.

Lower risk of care and twice the income

The desire for more solidarity remains in the system. With the previous coexistence of social and private long-term care insurance, there can be no question of a balanced distribution of costs between the two branches, say the authors of the WIdO. Example of distribution by age: According to your statistics, the proportion of people over 74 in the PPV is about a quarter lower than that of the SPV. This imbalance is exacerbated by the generally much higher proportion of women in social long-term care insurance, who particularly often need care at an advanced age. For women over 74 – only 47 percent private insurance and over 60 percent social insurance.

Even among the youngest in the PPV, the risk of needing care is significantly lower than average. For the 20 – to 50 – For the years it is “sometimes not even 20 Percentage of the corresponding risk of the Insured SPV”. One reason for this: the absence of any obligation to contract for people with a history of illness or disability. Then there are the differences in income. With an average gross total income of 54,334 PPV policyholders had on average EUR per year 2018, an income almost twice as high as the SPV policyholders. The latter would only appear on average 25. 313 euros.

All of this leads to completely different funding terms, according to the authors. With 2.7 people requiring care per 100 insured, the PPV must take care of only half as many people requiring care as the SPV. And with their performance spending (171 euros per inhabitant per year 2019) the private sector would make less than a third of the SPV spending. Even if one includes the care expenses financed by state aid for civil servants and retirees, the per capita expenditure in the SPV is 557 euros more than twice as high as in the PPV.

Citizen life insurance or structural compensation?

Individuals could pass this advantage on to their policyholders. “The cost of premiums for long-term care insurance in the PPV was in 2018 charged to 349 euros per insured,” he said in the WIDO analysis. In the SPV, contributions were “almost twice as high at 557 euros”. And at the same time, private insurers let a large part of their income and investment income flow into retirement provisions, which already stood at € 39 billion at the end of 2019.

With this very fact, however, experts on the other side argue, who oppose a PKV Financial Equalization (WIP). And if you use these withdrawn funds to expand the scope of SPV services (for example by capping the user fee in homes ), “The monitoring costs would be considerably higher in the already problematic years of demographic aging”.

In addition, the group of private policyholders is aging “Considerably faster” than that of social long-term care insurance. D that is to say Problems for private insurers would come with the birth cohorts 1942 to 1977. Based on the total number of insured, these 54 years accounted for 4% in the PPV and only 44.7% in the SPV. Concretely, it must be assumed that the the number of private policyholders needing care until 2030 to 74% will increase . For the SPV, one expects just one more percent. In addition, private insured persons in need of care are more often affected by “costly care cases” in care levels 4 and 5.

“Unbalanced load sharing”

At WIdO, however, they don’t see these possible changes as decisive. For reasons of equity, this is what the two scientists are asking for, all dependency insureds should in the future be included in solidarity financing. This could be done in two ways: through the introduction of uniform citizens’ care insurance or through structural adjustment, in which the higher financial strength of private policyholders would be taken into account. “Both options would be suitable to reduce the unbalanced distribution of costs between groups of insureds in the dual system, to broaden the basis of solidarity financing and thus contribute to a lasting stabilization of the financing of care.

It will be interesting to see if the FDP is ready to make such concessions in a traffic light coalition. The controversial citizens’ insurance has already been ruled out in the scoping document. The possibility of compensatory payments through the easier system remains unchanged.

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