Hospital.Help

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

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

It proposes four possible financing options: two within the framework of partial insurance and two full insurance options. The coalition parties announced the submission of this report in their coalition agreement. However, the submission was originally planned for last year.

Expenditure on statutory long-term care insurance has recently risen sharply. As the former deputy chairman of the GKV umbrella association, Gernot Kiefer, recently explained, a deficit of 650 million euros in social long-term care insurance was built up in the first quarter of 2024 alone. A deficit of 1.5 billion euros is expected for the year as a whole, said Kiefer, and a deficit of 3.4 billion euros in 2025.

Avoiding nursing cases through prevention

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

Lauterbach explained that the problem of financing nursing care insurance is solvable: “We are not facing an explosion in costs.” The minister assumes that costs can be reduced in the long term through prevention. “The most important thing that is underestimated here is the prevention of cases requiring nursing care,” said Lauterbach.

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

The reform of nursing care financing is to be accompanied by further laws which, among other things, are intended to lead to more nursing staff in the health care system: such as the Nursing Assistance Act and the Nursing Competence Act.

The government will therefore present an overall concept for care that will not only improve financing but also the range of care services and ensure that family carers are strengthened. However, he does not want to speculate on the details of the reform yet.

A collection of reform options

Before the minister’s announcements, associations and health insurance companies had pointed out how important it was to reform the financing of nursing care insurance during this legislative period. They criticized the working group’s report. It contained “few new findings and at best was a hodgepodge of reform options and eventualities,” said the chairwoman of the BKK umbrella association, Anne Kathrin Klemm.

The CEO of Techniker Krankenkasse, Jens Baas, explained: “The federal government’s report on nursing care financing merely summarizes known problems. Concrete action is required.” The long overdue nursing care reform must not be delayed again into the next legislative period.

He called for the federal government to relieve nursing care funds of non-insurance benefits and expenses incurred during the pandemic. “This does not require further problem analyses, but rather legislative initiatives,” Baas stressed.

Concern about bankruptcies

The chairwoman of the Association of Catholic Elderly Care in Germany (VKAD), Barbara Dietrich-Schleicher, also called on the federal government to take action in view of the deficit in the nursing care funds: “If the funds are soon no longer able to pay on time, the number of bankruptcies of nursing facilities will increase. The need for nursing care is huge – and the trend is increasing. Politicians must act decisively to prevent even more providers from getting into financial difficulties and the necessary care capacities from being reduced.”

“In addition to a fundamental reform of the financing of nursing care insurance that goes beyond the legislative period, immediate measures must be taken,” demanded Dietrich-Schleicher, citing the example of people in need of care who receive outpatient care.

“More and more people who are cared for at home are foregoing nursing services. If someone is foregoing personal care because it has become too expensive, then something is seriously wrong. Nursing care insurance must be set up in such a way that the gap between the increased prices and the nursing care benefits – which include personal care, care or housekeeping – is closed.”

The report is preceded by an inventory of the status quo. According to this, a large proportion of the approximately 5.2 million people in need of care are currently being cared for on an outpatient basis. Last year, this figure was around 84 percent. In these cases, it is usually the relatives who provide care and receive care allowance. Around 700,000 people are in full-time care, and around 140,000 are in inpatient facilities providing integration assistance.

According to the report, total expenditure on social long-term care insurance was around 59.2 billion euros in 2023. Of this, 36.2 billion euros went to outpatient services and 19.7 billion euros to inpatient services. Although only 13 percent of those in need of care receive full inpatient care, a 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: a combination of insured contributions, money from taxpayers and private contributions. Alternatively, the authors propose a further development of the current system in which the private contribution is reduced and a new, compulsory individual pension plan is introduced.

Two further proposals describe a pay-as-you-go full insurance system, which is financed either through contributions and tax revenues or solely through a pay-as-you-go system. © fos/aerzteblatt.de