Hospital.Help

Berlin – The Federal Audit Office (BRH) has called on the federal government to take measures that will bring about a lasting improvement in the financial situation of the statutory social long-term care insurance (SPV) in the short term.

“These measures should be taken during the current legislative period in order to ensure the continued existence of the SPV,” writes the BRH in its report on the current budget of the Federal Ministry of Health, which will be discussed in the Bundestag next week. There is still enormous pressure to act.

In order to offset the SPV’s deficit at the time, the federal government had raised the contribution rates in social long-term care insurance by 0.35 percentage points to 3.4 percent of gross income or to four percent for those without children as of July 1, 2023. In this way, it wanted to offset the billion-euro deficit that the SPV had incurred in 2021 and 2022.

“As a result of the contribution rate increase, the SPV achieved a surplus of 2.4 billion euros in the second half of 2023,” writes the Federal Audit Office. “It thus closed the financial year with a revenue surplus of 1.8 billion euros. However, the Federal Ministry of Health (BMG) had expected a higher surplus of 2.4 billion euros.”

No sustainable revenue surplus

As a result, the revenue surplus was not as sustainable as the BMG had hoped. “The fact that this expectation was not fulfilled is probably also due to the sharp increase in the number of people in need of care,” writes the BRH. “In 2023, the number increased to 5.2 million. This means that for the first time, more than five million people were in need of care.

The National Association of Statutory Health Insurance Funds estimated the increase last year at 361,000 people in need of care. In recent years, there had been an average increase of 326,000 people in need of care per year. This means that the increase in 2023 was eleven percent above the long-term average.

The BMG admitted that the reasons for the unexpectedly high increase are not yet known. It wants to have the reasons for the increase scientifically investigated.

In 2023, the BMG still assumed that the SPV would also achieve a surplus of more than 600 million euros in 2024 due to the increase in contribution rates. The ministry only expected a deficit of just under one billion euros for 2025 and a deficit of 2.5 billion euros for 2026.

“At present, the BMG considers it hardly possible to provide reliable estimates for the annual financial statements for 2025 and subsequent years, given the expected further increase in the number of people in need of care and the uncertain economic development,” writes the BRH. In any case, in the first quarter of the current year, the SPV incurred a loss of around 650 million euros.

According to the BRH, inpatient services have become the main driver of expenditure in nursing care insurance: above all, the expenditure for limiting co-payments. In the Nursing Care Support and Relief Act, the federal government limited the co-payments of those in need of care in order to curb the increase in co-payments for a nursing home.

Since then, the nursing care insurance has covered the corresponding expenses. According to the BRH, expenses rose by almost 40 percent to around 1.5 billion euros in the first quarter of 2024 compared to the same quarter last year.

“The Federal Ministry of Health has announced that it will launch a care reform during this legislative period,” writes the Federal Audit Office. “It would like to present the concept after the summer break.”

The financial situation of the SPV remains precarious, not least due to the continued significant increase in the number of people in need of care. “The measures taken during the corona pandemic are still having a negative impact on the financial situation of the SPV,” said the Court of Auditors.

“For example, the nursing care funds incurred expenses of over 4.4 billion euros to reimburse the test costs, which the federal government only partially reimbursed.”

The expectation that the increase in contribution rates would stabilize the SPV’s financial situation at least until the end of the legislative period has not been fulfilled. Instead, after only two quarters of surpluses, the SPV is once again reporting a deficit in the high three-digit million range.

“It can be assumed that at the turn of the year, expenditure will exceed income by billions,” said the BRH. “It cannot be ruled out that the federal government will have to take measures in the short term to ensure the financial viability of the SPV.” In any case, cosmetic measures are not enough to solve the SPV’s financial problems. © fos/aerzteblatt.de